Medigap Plan G vs. Plan N: Which Is Best?
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Medigap Plan G is the most comprehensive Medicare Supplement Insurance plan that’s available for purchase by all Medicare members. Medigap Plan N covers a bit less, but its premiums are lower, too.
The biggest difference between Medigap Plan G and Medigap Plan N is that Plan N has copays for certain medical office and emergency department visits, whereas Plan G doesn’t. If you wouldn’t need to pay the copays often, Medigap Plan N could cost less overall.
Here’s what you need to know to determine whether Medigap Plan G or Medigap Plan N is the best for you.
What’s the coverage difference between Plan G and Plan N?
Medigap Plan G and Plan N have mostly the same set of Medicare benefits, but there are a couple of key differences.
Benefits that are the same in both Plan G and Plan N
Here are the Medicare benefits that both Plan G and Plan N cover, according to Medicare.gov:
Part A coinsurance and hospital stays up to an additional 365 days after Medicare benefits are used up.
Part A deductible.
Part A hospice care coinsurance or copayment.
Skilled nursing facility care coinsurance.
Blood transfusion (first three pints).
Medically necessary emergency health care service for the first 60 days when traveling outside the U.S. Deductible and limitations apply.
Benefits that differ between Plan G and Plan N
Medigap Plan G and Plan N have two differences in coverage.
Part B excess charge coverage
Medigap Plan G covers Medicare Part B excess charges, while Plan N doesn’t. If a health care provider is legally permitted to charge more than Medicare’s approved amount and does so, what’s left over after Medicare’s approved amount is an excess charge.
Most health care providers have made an agreement with Medicare to accept the Medicare-approved amount for services, which means they can’t bill you for excess charges.
You can search for health care providers in your area that have made these agreements at medicare.gov/care-compare.
Part B coinsurance coverage
Medigap Plan G and Plan N both include Medicare Part B coinsurance coverage, but the level of coverage differs between the two plans. Plan G covers all of your Part B coinsurance, but Plan N doesn’t.
Rather than covering your entire Part B coinsurance, Medigap Plan N requires you to pay out of pocket for these visits:
Office visits: Copay is up to $20 for certain office visits.
Emergency room visits: Copay is up to $50 if you’re not admitted to hospital inpatient care.
After those copays, Plan N covers any additional Part B coinsurance for the visit. Plan N also pays the full Part B coinsurance for other types of visits covered by Medicare Part B.
What’s the cost comparison between Plan G and Plan N?
Medigap Plan G covers more than most other Medigap plans, and its premiums tend to be higher, too. Premiums for Plan N are lower because of its copay requirements.
Here are the lowest prices for each plan for a 65-year-old nonsmoker In North Carolina, a state with average costs for Medigap policies:
Medigap Plan G: $96.
Medigap Plan N: $72.
The best time to compare these prices and choose a plan is during your six-month Medigap open enrollment period, which starts the first month you have Medicare Part B and are 65 or older.
You’ll get the best prices during this period because insurance companies aren’t allowed to charge higher premiums or deny coverage because of your health or medical history.
Which should I choose: Plan G or Plan N?
Would you pay less with Medigap Plan N because of its lower premiums, or would the savings be outweighed by the copay requirements? That answer depends on two factors:
What’s the difference in premiums?
How often will you have office or emergency visits?
In the earlier example, the difference in premiums is $24 per month. That difference accounts for about one $20 office visit copay every month or about one $50 emergency visit copay every other month.
Medigap Plan G vs. Plan N calculator
Consider Plan N if you have relatively few health care visits
If you don’t have many medical office or emergency visits, the premium savings from Plan N might be worthwhile.
For example, say Plan N costs $25 less per month than Plan G. That’s a difference of $300 for the whole year.
If you have four office visits with $20 copays and one emergency visit with a $50 copay over the course of the year, that’s $130 in out-of-pocket costs. You would end up saving $170 ($300 - $130 = $170) for the year as compared to Plan G.
Consider Plan G if you have frequent visits or prefer predictable costs
If you tend to have more frequent visits to your health care providers, Plan G might be the better deal.
For example, take the same $25 difference in monthly premiums between Plan G and Plan N — $300 for the year.
If you had one $20 office visit copay per month (so 12 per year) and one $50 emergency copay per year, that adds up to $290 in out-of-pocket costs. With a $300 annual difference in premiums, you would save $10 per year with Plan N ($300 - $290 = $10). If you had any more visits than that, the difference in premiums wouldn’t be enough to cover the out-of-pocket costs.
You might also want to opt for Plan G for the sake of predictability. It’s hard to guess how many office or emergency visits you might have, so there’s more uncertainty with what you’ll spend for Plan N. Plan G’s premiums may be higher, but you know in advance what you’ll have to pay each month.
Find the right Medicare Supplement Insurance plan
Because Medigap plans are standardized, you can get precisely the same Medicare benefits from any company offering the plan. So when you shop, keep these considerations in mind to find the best policy to fit your needs:
Is your preferred plan available? Health insurance companies don’t always sell every plan, so check who sells the plan you want to buy in your area.
What are the premiums? Prices for the same plan can vary between companies, so check to find the most competitive rates.
Will your premiums change over time? Most policies cost more as you age, but some companies offer policies that let you lock in a price when you sign up.
Are there extras? Medigap plans’ core benefits are standardized, but in certain cases, some companies include such perks as discount programs or gym memberships.