How to Choose Between Medigap Plan G and Plan N in 2026: The $283 Deductible, the Excess-Charge Trap, and the Premium-Gap Math That Picks a Winner

If you are choosing a Medicare Supplement plan for the first time in 2026 — or thinking of switching — the shortlist for most people comes down to two: Medigap Plan G and Medigap Plan N. Plan F is closed to anyone who became Medicare-eligible on or after January 1, 2020, so it's off the table for new enrollees. Plans A, B, D, K, L, and M exist but leave enough gaps that few brokers seriously recommend them. The real decision is Plan G versus Plan N — and it comes down to three numbers, one state law, and a break-even formula that takes about five minutes to run.

This guide walks through the exact 2026 differences (including the fresh $283 Part B deductible and the $2,950 high-deductible Plan G threshold), the excess-charge trap that trips up Plan N buyers in 42 states, three real-money scenarios, and the underwriting risk that makes "start on Plan N, switch to Plan G later" a much more fragile plan than it sounds.

Plan G covers every gap in Original Medicare except the annual Part B deductible. Plan N covers the same gaps except the Part B deductible, small office-visit and ER copays, and Part B excess charges. Everything else — the important stuff, like the 20 percent Part B coinsurance, the Part A deductible ($1,676 per benefit period in 2026), skilled nursing coinsurance, and the extra 365 hospital days after Original Medicare runs out — is covered identically by both plans.

Before you compare quotes, memorize four figures. Everything downstream depends on them.

The $283 figure is the biggest change from 2025 (up from $257). Both plans require you to spend it before either kicks in on the Part B side, so it is not a differentiator — it is a shared cost you will pay under either choice.

Part B excess charges are the sleeper issue in the Plan G vs Plan N decision. Federal law lets any doctor who is enrolled in Medicare as a "non-participating provider" bill you up to 15 percent above the Medicare-approved amount. Plan G eats that surcharge; Plan N sends it to you as an out-of-pocket balance.

In practice, most doctors (roughly 96 percent nationally) accept Medicare assignment and never issue excess charges. But eight states have simply banned them: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. If you live in one of those eight, the excess-charge gap in Plan N is essentially theoretical — a non-participating provider cannot bill you above the Medicare rate no matter what.

In the other 42 states, whether excess charges bite depends on the specialists you use. Certain fields — psychiatry, some surgical subspecialties, boutique concierge practices — have a higher share of non-participating providers. If you already know your favorite dermatologist or gastroenterologist doesn't take assignment, and you cannot easily switch, Plan G's excess-charge coverage is worth the premium differential on its own.

Once you know the state answer, the rest is arithmetic. Pull two quotes for the same insurance company in your ZIP code: one for Plan G and one for Plan N. Then run this:

1. Annual premium gap = (Plan G monthly premium − Plan N monthly premium) × 12.
2. Expected Plan N cost-sharing = (expected office visits × $20) + (expected ER visits × $50) + (estimated excess charges).
3. If (2) is less than (1), Plan N wins. Keep the premium savings, absorb the copays.
4. If (2) is greater than (1), Plan G wins. Pay the extra premium to lock in zero cost-sharing.

This is not a marketing exercise — it is the same math a fee-only advisor would run. The break-even point most commonly lands somewhere between 12 and 20 annual office visits, depending on how big the premium gap is in your area. Below 12 visits, Plan N almost always wins. Above 20, Plan G almost always wins.

Scenario 1: Healthy New Retiree in Ohio — Plan N Wins by $360

Diane, 66, just aged into Medicare in Cleveland. She sees her primary care doctor twice a year and a physical therapist eight times for a shoulder issue. She has no chronic conditions. Ohio is one of the eight states that bans excess charges, so that gap is off the table. A local Plan G quote is $148/month; Plan N is $118/month. Annual premium gap: $360. Plan N cost-sharing: 10 office visits × $20 = $200. Plan N wins by $160 for the year. Even if she has one unexpected ER visit (adding $50), Plan N still wins by $110. Over ten years — assuming premiums scale similarly — that's roughly $1,100 to $1,600 of savings, and she gives up nothing in coverage that Ohio law lets a provider charge her.

Scenario 2: Snowbird With Multiple Specialists in Florida — Plan G Wins by $500+

Roberto, 71, splits time between Orlando and a lake cabin. He sees a cardiologist, an endocrinologist, and a rheumatologist regularly — 22 specialist visits a year, plus four primary care visits and typically one ER trip. His rheumatologist is a "non-participating" provider who bills the 15 percent excess charge, roughly $80 above Medicare-approved per visit ($320 a year in excess charges alone). Plan G is $172/month; Plan N is $132/month. Annual premium gap: $480. Plan N cost-sharing: 26 visits × $20 + 1 ER × $50 + $320 excess = $890. Plan G wins by roughly $410 the first year, and the gap grows if he needs a surgery or infusion later. For Roberto, Plan G's zero-copay design is the safer purchase and the cheaper one on expected cost.

Scenario 3: Very Healthy 65-Year-Old in Texas — High-Deductible Plan G Wins by $900

Karen, 65, works part-time, has no chronic conditions, and only expects an annual physical (fully covered by Part B preventive services with no cost-sharing). Standard Plan G in her ZIP is $155/month. High-deductible Plan G is $52/month. Plan N is $122/month. Karen's expected medical spend is roughly $0 beyond the Part B deductible she already owes. Her three options over a year cost her $1,860 (Plan G), $1,747 (Plan N + ~10 visits' worth of copay + deductible), and $624 (HD-Plan G, assuming she stays healthy and does not hit the $2,950 deductible). HD-Plan G wins by roughly $900 in a healthy year. The catch is downside risk: if Karen has one bad year with a hospitalization, she'll pay the $2,950 HD deductible plus premiums (~$3,574 total) instead of the standard Plan G's ~$1,860. HD-Plan G is a bet on continued health.

Your Medigap Open Enrollment Period is a one-time, six-month window that starts the month you turn 65 and enroll in Part B. During that window, insurers must sell you any Medigap plan they offer at the standard rate, regardless of pre-existing conditions or health history. This is the strongest consumer protection in Medicare.

Once that six-month window closes, most states allow insurers to medically underwrite any Medigap application. That means if you enroll in Plan N at 65 to save on premium and try to switch to Plan G at 68 because your health worsened, the insurer can look at your medical records, decline your application entirely, or charge a substantially higher premium reflecting your new risk. Exceptions exist:

• Guaranteed-issue triggering events — such as your Medigap insurer going bankrupt, moving out of an Advantage plan's service area, or the "trial right" for switching from Advantage back to Original Medicare within the first 12 months.
• State laws that mandate broader switching rights. California, Connecticut, Maine, Massachusetts, Missouri, New York, Oregon, and Washington each have some flavor of continuous or annual guaranteed-issue switching, though the specifics vary widely (Maine and Missouri, for example, tie the right to an "anniversary" window).

If you are choosing between Plan N and Plan G partly on the theory that you'll "start cheap and upgrade later," check your state's rules before you commit. In the majority of states, upgrading is not guaranteed, and the door effectively closes after your Open Enrollment Period. If you are unsure you can pass future underwriting, the decision effectively becomes "pick the plan you want to keep for the next 20 years," which usually pushes toward Plan G. See our companion guides on switching from Medicare Advantage back to Original Medicare and the HSA six-month lookback trap for other timing decisions that lock in for years.

The high-deductible variant of Plan G is a genuinely different product. You take on the first $2,950 of covered medical spend each year (2026 figure, up from $2,870 in 2025), and after that, HD-Plan G pays exactly like standard Plan G. In exchange, the monthly premium is typically 60 to 70 percent lower.

HD-Plan G tends to make sense when:

• You are healthy at enrollment and expect very low utilization in your first several years of Medicare.
• You want the peace of mind of a defined maximum ($2,950 plus premiums) without paying for first-dollar coverage you don't expect to use.
• You have savings you can readily tap to cover the $2,950 in a bad year without stress.
• You live in a state where you have flexibility to switch plans later without underwriting.

It tends to not make sense when:

• You already have chronic conditions with regular specialist care.
• You expect a planned surgery or procedure in the coming year.
• You do not have savings to cover $2,950 in a spike year and would rather trade higher premium for smoothed cost.
• You live in a state where an eventual upgrade to standard Plan G will require passing underwriting.

Mistake 1: Comparing plans across insurers on features alone

Medigap plans are federally standardized by letter. A Plan G is a Plan G is a Plan G — the coverage is identical whether you buy it from AARP/UnitedHealthcare, Mutual of Omaha, Aetna, Cigna, or a Blue Cross plan. The only real difference is price and the insurer's rate-history stability. Two insurers can charge $80/month difference for exactly the same coverage. Always compare at least three carriers before enrolling, and ask about the insurer's rate-increase pattern over the past five years, not just the current premium.

Mistake 2: Ignoring the rating method

Medigap premiums are set one of three ways: attained-age (premium rises as you get older), issue-age (premium locked at your age when you enrolled, with annual inflation adjustments), or community-rated (same premium for everyone regardless of age). Attained-age plans are typically cheapest at 65 and most expensive at 85; community-rated plans are the opposite. If two quotes are close today but one is attained-age and one is community-rated, the community-rated plan is often much cheaper over a 20-year horizon. Ask the broker to show you the projected premium at age 75 and 85, not just today.

If you have 15 minutes, you can settle this today:

1. Confirm your state: is it one of the eight that ban Part B excess charges? If yes, that gap in Plan N is theoretical.
2. Estimate your annual utilization: primary care visits, specialist visits, expected ER trips, any planned procedures. Round up if you're unsure — sicker projections favor Plan G.
3. Pull three quotes each for Plan G and Plan N from different insurers in your ZIP code. Verify the rating method (attained-age vs issue-age vs community-rated).
4. Calculate the annual premium gap and your expected Plan N cost-sharing using the formula earlier in this piece.
5. Consider your state's Medigap switching rules. If you are outside California, Connecticut, Maine, Massachusetts, Missouri, New York, Oregon, and Washington, treat the decision as roughly permanent.
6. If HD-Plan G is a real contender (very low expected utilization, healthy today, savings to cover $2,950), price it as a third option and stress-test with a bad-year scenario.
7. Enroll during your six-month Medigap Open Enrollment Period if you have not already used it. Guaranteed-issue rights outside that window are limited.

Neither Plan G nor Plan N is a bad choice — both are legitimate, well-designed products, and the standardized coverage is genuinely excellent. The mistake is treating this as a preference decision when it's actually an arithmetic one. Run the premium-gap math against your real utilization and your state's excess-charge rules, and the "right" plan for your situation usually announces itself in a few minutes.