Plan Coverage Comparison

Plan G Coverage:

• Covers ALL Medicare cost-sharing EXCEPT the Part B deductible
• No copays for doctor visits or emergency rooms
• Covers excess charges (up to 15% above Medicare-approved amounts)
• Comprehensive coverage with predictable costs after meeting Part B deductible

Plan N Coverage:

• Covers most Medicare cost-sharing with these exceptions:
• Part B deductible ($257 in 2025)
• Up to $20 copay for doctor visits
• Up to $50 copay for emergency room visits (waived if admitted)
• Does NOT cover excess charges

Claims Scenarios

Scenario 1: Regular Doctor Visits

Assume 6 doctor visits per year at $200 each ($1,200 total)

Plan G:

• You pay: $257 (Part B deductible)
• Plan pays: $943
• Your total: $257

Plan N:

• You pay: $257 (Part B deductible) + $120 (6 × $20 copays)
• Plan pays: $823
• Your total: $377

Scenario 2: Emergency Room Visit + Hospitalization

ER visit leading to hospital admission, total Medicare-approved amount: $25,000

Plan G:

• You pay: $257 (if Part B deductible not yet met)
• Plan pays: Everything else
• Your total: $257

Plan N:

• You pay: $257 (Part B deductible, if not yet met)
• Plan pays: Everything else (ER copay waived due to admission)
• Your total: $257

Excess Charges: The Hidden Risk

What are Excess Charges?

Excess charges occur when doctors who accept Medicare but don't accept assignment charge up to 15% more than Medicare's approved amount. For example, if Medicare approves $1,000 for a procedure, the doctor can charge up to $1,150.

The Risk:

• Only about 4% of providers charge excess charges, but it can be expensive when it happens
• Plan N does NOT cover these charges
• Plan G DOES cover excess charges completely

How to Mitigate Excess Charge Risk with Plan N:

1. Always verify that your doctors accept Medicare assignment before treatment
2. Ask specifically: "Do you accept Medicare assignment?" (not just "Do you take Medicare?")
3. Use Medicare's physician directory to find assignment-accepting providers
4. Get written confirmation for expensive procedures
5. Consider staying within large health systems that typically accept assignment

Premium Considerations

While specific premiums vary by location and insurer, Plan N typically costs $30-60 less per month than Plan G. However, this savings can be offset by copays if you're a frequent healthcare user.

Recommendations

Choose Plan G if you:

• Want maximum predictability and comprehensive coverage
• Are a frequent healthcare user (6+ doctor visits per year)
• Don't want to worry about copays or excess charges
• Value peace of mind over premium savings
• Have chronic conditions requiring regular specialist visits
• Can afford the higher premium for complete coverage

Choose Plan N if you:

• Are generally healthy with infrequent doctor visits
• Want to save on monthly premiums
• Don't mind small copays for routine visits
• Are comfortable verifying that providers accept Medicare assignment
• Typically use 4 or fewer doctor visits per year
• Want good coverage at a lower cost

The Bottom Line

Plan G offers the most comprehensive coverage available to new Medicare beneficiaries, while Plan N provides excellent value for healthier individuals who don't mind managing small copays and being vigilant about excess charges. The "sweet spot" where Plan N saves money is typically for people with 4 or fewer doctor visits per year, assuming they consistently use providers who accept Medicare assignment.

The choice often comes down to your health status, budget, and preference for predictability versus managing small out-of-pocket costs.