What Does Medigap Plan G Cover That Plan N Does Not

Medigap Plan G covers Medicare Part B excess charges and does not require copayments for doctor or emergency room visits, while Plan N leaves you responsible for up to 15% in excess charges and charges copays of up to $20 for office visits and $50 for ER visits.

Medigap Plan G and the part B excess charge gap

Original Medicare Part B pays 80% of approved charges for doctor services, but only if the doctor accepts assignment. When a physician does not accept assignment, they can legally bill you an additional 15% above what the federal program approved, this is the Part B excess charge. Plan G steps in and pays that full 15% with no deductible and no coinsurance on your end. Plan N, by contrast, leaves you holding that entire 15% liability on every claim from a non-participating provider.

The practical effect is that a single surgery or a series of specialist visits from a doctor who doesn’t accept assignment could cost you hundreds or even thousands of dollars under Plan N. For example, if the government health plan approves a procedure at a rate set by the Centers for Medicare & Medicaid Services, the excess charge is an additional 15% calculated on that approved amount, and Plan N makes you pay that out of pocket. Plan G writes a check for the full amount. The catch is that most doctors do accept assignment, so this gap only appears when you choose a provider who doesn’t. The key is checking your state: some states like Ohio and Pennsylvania ban excess charges entirely, while others like California and New York require doctors to accept assignment for patients on the federal insurance. In those states, the gap between Plan G and Plan N on this specific point shrinks to zero.

Office and emergency room copays

Plan N charges a copay for every covered office visit and a copay for emergency room visits, but only if you are not admitted to the hospital. Plan G eliminates both copays completely. This means under Plan G, you walk into any doctor’s office or ER and pay nothing at the point of service; under Plan N, you hand over cash or a card for every visit, even if the visit turns out to be a false alarm. The specific copay amounts are set by each private insurance carrier and can be found in the plan’s official summary of benefits.

The ER copay has a specific condition worth noting: if you go to the emergency room and are admitted to the hospital, the copay is waived. If you are treated and released, you owe the amount stated in your policy. That might seem minor, but it changes how you behave. Under Plan N, a minor injury that sends you to the ER, a sprained ankle, a bad cut, a high fever, costs you that copay every time. Under Plan G, that same visit costs nothing. The office visit copay is even more frequent: if you see a primary care doctor monthly for a chronic condition, the annual total is set by multiplying the per-visit charge defined by your insurer by twelve, all of which Plan G covers.

When Plan N’s trade-off makes sense anyway

The failure case is assuming Plan N is strictly worse because of those copays and the excess charge exposure. In reality, the lower monthly premium often outweighs the copay risk for healthy enrollees who rarely see a doctor. Plan N typically costs 30% to 40% less per month than Plan G, depending on your state and insurer. For a 65-year-old in good health, that can mean saving a significant sum every single month, hundreds of dollars a year, while paying only a handful of office-visit copays. The exact premium difference is published by each insurance company and changes annually, so you must check the insurer’s official rate sheet for your age and ZIP code.

Consider the math for a typical year: you see a specialist twice, your primary care doctor three times, and you skip the ER entirely. That is five copays at the per-visit rate your carrier charges, and if Plan N saves you a larger amount in premiums, you are ahead even after paying those copays. The excess charge gap is the wildcard, but you control it by asking every provider upfront, “Do you accept Medicare assignment?” If the answer is yes, that risk never materializes. This is also why you should always compare Medicare advantage plans against original Medicare with a Medigap policy, because Plan N gives you the freedom to use any doctor who accepts the national health program, something an Advantage HMO network will never match. For a healthy person who wants low monthly costs and catastrophic protection, Plan N’s trade-off is a deliberate, rational choice.

That single sentence is the entire practical difference between the two most popular Medigap plans sold today, and it explains why Plan G carries a higher monthly premium.

Frequently asked questions

Can I switch from Plan N to Plan G later without a medical exam?

No, not generally. Medigap plans sold after 1990 are not guaranteed-issue after your initial enrollment window, so switching from Plan N to Plan G usually requires medical underwriting, which means you could be denied or charged more based on your health.

Does Plan N cover the Part A deductible?

Yes, both Plan G and Plan N cover the Part A hospital deductible in full, along with coinsurance for hospital stays up to 365 additional days after the national health program’s benefits are exhausted.

Are excess charges common in states that allow them?

They are uncommon but not rare, roughly 2% to 5% of physicians who accept the federal insurance do not accept assignment, and those who do often work in high-cost specialties like anesthesiology or surgical assisting.

Does the ER copay apply if I call an ambulance?

No, the copay applies only to the emergency room facility charge, not to ambulance transport. Ambulance services are covered under Part B separately, and Plan N does not impose a copay on that line item. For a deeper look at how these and other coverage nuances fit into your overall strategy, explore the broader topic of Healthcare & Medicare: What to Know and How to Handle It.