Standard Medigap Plan G covers Medicare Part B excess charges; Plan N does not. But doctors who accept Medicare assignment cannot bill those excess charges for covered services. Compare the actual premium difference, Plan N copayments and your doctors' billing practices before choosing, and check your eligibility to buy or switch policies.
A doctor who takes Medicare may still charge more than Medicare’s approved amount if the doctor does not accept assignment for your visit. That distinction matters when comparing Medigap Plan G with Plan N: standard Plan G covers Medicare Part B excess charges, while Plan N does not. Before paying extra for that protection, check whether the doctors you use accept assignment.
Three provider situations—and what they mean for your bill
Under Medicare’s assignment rules, a participating provider accepts the Medicare-approved amount as full payment for covered services. You still owe applicable deductibles and coinsurance, but not a Part B excess charge. A non-participating provider may accept assignment for a particular service or may charge more, subject to applicable limiting-charge rules. Medicare says that in many cases the additional charge cannot exceed 15% of the Medicare-approved amount. That is not a universal 15% surcharge on every Medicare bill.
A provider who has opted out is different. Except for certain emergency circumstances, Medicare generally does not pay for care under a private contract with an opted-out provider. Medigap excess-charge coverage is not a substitute for Medicare coverage in that situation. Confirm which of these three categories applies before treatment.
Plan G versus Plan N: which costs are different?
The official Medigap benefit comparison shows that standard Plan G pays Part B excess charges; standard Plan N does not. Neither standard plan pays the Part B deductible. Plan N can also require copayments of up to $20 for some office visits and up to $50 for emergency department visits when you are not admitted as an inpatient. Both plans have other standardized benefits, so the excess-charge row alone is not a complete price comparison.
Do not confuse standard Plan G with its high-deductible version, which has an additional deductible before the policy pays. Plans F and G have special variants in some states; Plan F also has eligibility restrictions. In Massachusetts, Minnesota and Wisconsin, Medigap standardization differs from the familiar lettered plans, so check your state’s offerings.
Worked example: when the premium difference matters more
Imagine two available quotes for standard policies: Plan G costs $25 more per month than Plan N, or $300 more over 12 months. Suppose your non-participating doctors’ actual allowed excess charges total $180 during that year. In this deliberately simplified comparison, Plan G would save $180 in excess charges but cost $300 more in premiums—a $120 difference before considering Plan N office or emergency-room copayments and other personal costs.
Those $25 and $180 figures are hypothetical, not insurer quotes or Medicare estimates. A person with frequent non-assignment visits may reach a different result; a person whose doctors always accept assignment may have no excess charges to insure against. Do not treat the 15% limiting-charge rule as a prediction of your bill. Compare actual quotes and provider billing practices.
What to check before choosing or changing a policy
First, ask each doctor: “Do you accept Medicare assignment for my covered services?” Medicare recommends checking directly, and its provider payment guidance explains why. If the answer is no, request an estimate of any excess charge for the specific covered service and ask whether the doctor will accept assignment for that visit.
Second, compare standard Plan G and Plan N quotes from several insurers in your ZIP code. Medicare notes that benefits for the same standardized letter are the same across insurers, but premiums can vary substantially. Add the annual premium difference to expected Plan N copayments and any realistic excess-charge exposure; do not compare premiums alone.
Third, check whether you can actually buy the policy. Medicare’s Medigap basics explain that the federal six-month Medigap open-enrollment period generally starts when you are at least 65 and enrolled in Part B. Outside protected enrollment or guaranteed-issue situations, an insurer may be able to deny an application or charge more. Changing Medicare Advantage coverage does not automatically guarantee every Medigap option. See Medicare’s buying guidance before canceling existing coverage.
If you are already weighing Medicare coverage for next year, our guide to Medicare Advantage plan non-renewal explains a different set of switching rights. For a free impartial discussion of local Medigap rules, contact your State Health Insurance Assistance Program through the official Medicare guidance. This article was prepared with AI assistance and checked against Medicare.gov sources; it is general information, not an individual coverage recommendation.
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