Medicare Plan N (2026–2027): Costs, Copays and Coverage Gaps
Bottom Line
Plan N may pay off when savings over standard G exceed visit copays and possible excess charges. Both leave the Part B deductible; ask whether doctors accept Medicare's approved amount in full and whether returning to G requires health review.
Medicare Supplement Plan N can be a good value when its premium is meaningfully lower than Plan G and you can budget for its coverage gaps. It pays much of Original Medicare’s cost sharing, but leaves you responsible for the Part B deductible, certain visit copays and any permitted Part B excess charges.
If you are also evaluating permanent life insurance, comparing IUL companies is a separate decision from choosing Medicare coverage.
How Plan N fits with Medicare
As you explore Medicare Supplement plan options, remember that Medigap and Medicare Supplement are two names for the same insurance category. Plan N’s basic benefits are standardized across insurers in states using lettered plans. Massachusetts, Minnesota and Wisconsin use different standardization systems.
You generally need Original Medicare Parts A and B to buy Plan N. Medicare pays its share first, and Plan N pays according to its benefits. Medicare Advantage is a different way to receive Medicare coverage; Plan N cannot pay Medicare Advantage cost sharing.
Original Medicare lets you use doctors and hospitals that accept Medicare nationwide. Check providers’ Medicare participation and assignment policies before receiving care.
What Plan N covers
These benefits apply within Medicare’s coverage requirements and the policy’s limits.
| Expense | Plan N benefit |
|---|---|
| Part A hospital deductible | Covered |
| Hospital coinsurance | Covered, with up to 365 additional hospital days after Medicare benefits are exhausted |
| Skilled nursing facility coinsurance | Covered for Medicare-covered care |
| Part A hospice cost sharing | Covered |
| Blood | Covers the first three pints |
| Part B coinsurance | Covered except for the office and emergency room copays described below |
| Part B deductible and excess charges | Not covered |
| Emergency care abroad | Limited coverage, described below |
Skilled nursing coinsurance coverage does not turn Plan N into long-term care insurance. Medigap generally excludes custodial long-term care, routine dental and vision care, hearing aids, eyeglasses and private-duty nursing. Budget separately for those needs.
For qualifying emergency care abroad that Medicare does not cover, Plan N pays 80% of eligible billed charges after a $250 annual deductible, subject to a $50,000 lifetime benefit limit. The emergency care must begin during the first 60 days of the trip.
How the office and emergency room copays work
After you satisfy the Part B deductible, Plan N leaves copays of up to $20 for some office visits and up to $50 for emergency room visits that do not result in inpatient admission. These are maximums for the specified visits, not a flat charge on every Part B service.
An overnight hospital stay does not necessarily mean you were admitted. Observation care is outpatient care, so ask whether your status is inpatient or outpatient when checking the emergency room copay.
Plan N has no annual out-of-pocket spending cap. Its copays are individual limits, not a yearly ceiling on your remaining expenses.
Excess charges: the other gap to check
Accepting Medicare assignment means accepting Medicare’s approved amount as full payment for a covered service. Providers who do not accept assignment may charge more. In many cases, the federal limit is 15% above the approved amount for nonparticipating providers. Plan N does not cover permitted excess charges.
Ask each provider’s billing office whether it accepts assignment for your care. Asking only whether an office “takes Medicare” does not settle that question. A provider who opts out of Medicare is a separate situation: Medicare generally does not pay that provider, except in emergencies.
What Plan N costs in 2026
There is no single national Plan N premium. Insurers set their own prices, and location, discounts and underwriting can affect your cost. Premiums typically increase each year. Compare quotes for the same coverage start date and ask whether any quote is a Medicare SELECT policy, which can restrict providers for full benefits.
Your budget includes more than the supplement premium:
- Your monthly Plan N premium.
- Your Part B premium: the standard amount is $202.90 per month in 2026; higher-income beneficiaries pay more.
- Any Part A premium you owe.
- The $283 annual Part B deductible in 2026.
- Applicable Plan N copays, excess charges and expenses outside the policy’s coverage.
- Separate Part D premiums and drug costs if you enroll in a drug plan.
The federal amounts above are for 2026, not estimates of 2027 costs.
Compare the annual cost with Plan G
Evaluating Plan G versus Plan N over a full year means comparing premiums plus the costs left when you receive care. Standard Plan G covers Part B excess charges and does not have Plan N’s office and emergency room copays. Neither covers the Part B deductible.
Consider this hypothetical calculation, not an available rate or savings promise:
| Assumption for one year | Amount |
|---|---|
| Plan N premium is $30 less per month than Plan G | $360 lower annual premiums |
| Six office visits with $20 copays | $120 |
| One emergency room visit with a $50 copay | $50 |
| Excess charges | $0 |
| Plan N’s remaining cost advantage | $190 |
This assumes the visits occur after the Part B deductible is met and the emergency visit does not lead to inpatient admission. It compares standard Plan G with Plan N, not high-deductible Plan G. Other coverage and spending are held equal.
At that hypothetical premium difference, 18 office copays of $20 would use up the $360 before any emergency copays or excess charges. Run both an ordinary year and a year with more visits.
Plan N deserves consideration when the quoted premium difference comfortably exceeds the extra costs you can reasonably budget for. Plan G may justify a higher premium if you want to avoid those visit copays or protect against excess charges.
Make the prescription decision separately
Plan N does not include Part D prescription coverage. When pairing Plan G or Plan N with Part D, compare a standalone drug plan using your medications and pharmacies, unless you already have suitable drug coverage.
Use your current drug list to compare estimated annual costs, rather than choosing by premium alone. Medicare’s comparison tools can estimate monthly and yearly drug spending.
After your initial enrollment period, going 63 consecutive days without Part D or other creditable prescription coverage can trigger a late enrollment penalty. Creditable coverage means drug insurance expected to pay at least as much as Medicare drug coverage, on average. Confirm that status before delaying Part D.
Check whether you can buy or switch to Plan N
Your federal Medigap open enrollment period lasts six months, starting the first month you are at least 65 and have Part B. During it, insurers cannot reject you or charge more because of health problems. Outside that window, medical underwriting may apply unless you have a qualifying protection. People under 65 need to check their state’s purchase rights.
The October 15–December 7 Medicare open enrollment window concerns Medicare Advantage and drug plan changes. It does not generally guarantee a Medigap purchase without underwriting.
When checking the savings from Plan G to Plan N, obtain approval and a confirmed start date before canceling existing coverage. Also check whether you could return to G later; a change in health could limit that option. Guaranteed issue rights do not always include Plan N.
State exceptions matter. For example, holders of policies issued in Maryland get their birthday and the following 30 days to apply for a switch to equal or lesser benefits without underwriting. Maryland’s chart allows standard G to N, but does not include N to G. That is a Maryland rule, not a nationwide right.
Prepare a useful quote comparison
Request written Plan N and standard Plan G quotes using the same ZIP code, age, tobacco status, start date and discount eligibility. Ask how premiums change with age, whether discounts expire, and whether underwriting or a waiting period applies. Compare the final approved premium before making a replacement decision. Medicare recommends getting official quotes from more than one company and reading the policy.
Bring those quotes together with your provider assignment checks, expected visits, prescription costs and enrollment dates. Choose the combination whose total annual cost and remaining bills fit your budget, including a year when you need more care.