Medigap Plan N Costs Less Than Plan G Every Month. The Savings Ride on One Bill Some Doctors Are Legally Allowed to Send

A 65-year-old shopping Medigap during her six-month open enrollment window pulls two quotes from the same insurer. Plan G costs more per month. Plan N costs less. She lines up the benefit charts side by side and they look nearly identical, so she takes Plan N and moves on.

Two years later she has a shoulder arthroscopy. The surgeon is enrolled in Medicare but doesn’t accept assignment, and a bill arrives for the difference between what Medicare approved and what he’s allowed to charge. Her neighbor, who bought Plan G, wouldn’t have received that bill at all. Nothing went wrong. She bought the plan that leaves exactly one thing uncovered, and then she met it.

What the Two Plans Share

Plan G and Plan N cover most of the same ground: the Part A hospital deductible, hospital coinsurance, skilled nursing coinsurance, the first three pints of blood, hospice cost-sharing, and 80% of foreign travel emergencies up to plan limits. Both leave you the annual Part B deductible, which is $283 in 2026.

Plan N departs in three places. It applies a copay of up to $20 for office visits and up to $50 for emergency room visits that don’t end in admission. And it doesn’t pay Part B excess charges. Plan N does cover your ordinary 20% Part B coinsurance after the deductible. The excess charge is a separate item that sits on top of the deductible and whatever copay applies. It isn’t the 20%.

Who Can Actually Send That Bill

Medicare sorts physicians into three buckets, and only the middle one matters here. Participating providers accept Medicare’s approved amount as payment in full, apart from deductible. Opted-out providers have formally left the program and bill privately. In between sit enrolled but non-participating providers, who can bill above the approved amount on claims they don’t assign.

The mechanics deserve precision, because two numbers are in play. A non-participating provider’s approved amount is already set at 95% of the participating fee, and the federal limiting charge generally caps what they can bill at 115% of that lower figure. Medicare.gov describes the rule as applying “in many cases,” since it doesn’t reach every service or supplier in the same way. That 15% margin is the Part B excess charge. Plan G covers it; Plan N does not.

KFF found that roughly 1.2% of non-pediatric physicians had formally opted out of Medicare, drawing on March 2022 opt-out data. Opting out is a different status from being enrolled and non-participating, so that figure tells you nothing about how many doctors might send an excess charge.

Your State May Already Handle This

Several states restrict Part B excess charges, which can change the calculation substantially. But the protections aren’t uniform, and calling them a blanket ban would be wrong. Whether one reaches you depends on more than your address. Where the care is delivered matters.

So can your income, the type of service, and whether the provider made required disclosures. Connecticut’s protection is income-limited. Vermont’s statute carries explicit exceptions, and New York permits certain charges above Medicare’s rate. Rhode Island attaches disclosure-based conditions. Massachusetts, Minnesota, Ohio and Pennsylvania are also commonly listed. Call your state insurance department, ask what your state actually does, and ask whether the protection follows you to care delivered elsewhere.

Weighing the Monthly Savings

The premium gap between the two plans is real money every month, and in a calm year it comfortably covers a handful of $20 office copays with room left over. The risk sits on the other side. A single large physician fee from a non-participating specialist can wipe out a year’s worth of that savings. Going further than that, to multiple years, needs a worked example with a real approved amount behind it, because the excess charge applies only to the physician’s fee rather than to the whole hospital or facility bill.

So the decision comes down to two questions. Does your state limit excess charges, and do your regular doctors accept assignment? Two yeses make Plan N the stronger buy. A no on either one is an argument for Plan G, or at least for pricing both with the same insurer before you sign. Excess charges are one of several Medicare costs that never show up on a premium quote and arrive in the mailbox instead. We cataloged the rest, from IRMAA surcharges to coverage gaps, in a free guide to Medicare’s hidden bills.

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