Newsroom · Grand Junction
Medigap Plan G vs. Plan N: Which Costs Less in Colorado?
Two plans, three differences, and one number that settles it — how many times a year you actually walk into a doctor's office.
The bottom line
- Plan N costs less in premium and more at the counter. That's the entire trade.
- On Medicare's own chart, G and N differ on exactly two lines: Part B excess charges, and a copay of up to $20 for some office visits plus up to $50 for an ER visit that doesn't end in admission.
- Neither covers the Part B deductible — $283 in 2026. Neither covers drugs, dental, vision, hearing, or long-term care.
- The break-even is arithmetic: a $25-a-month gap is $300 a year, or roughly 15 capped office visits.
- Excess charges are rare but Colorado is not an average state for doctors standing outside the Medicare payment system — KFF puts Colorado's opt-out rate at 2.3% against 1.2% nationally.
- Colorado has no Medigap birthday rule, so switching later usually means health questions. Choose deliberately the first time.
Almost every Medigap conversation I have in Mesa County comes down to these two letters. Plan F closed to newcomers, Plan G became the default, and then somebody's neighbor mentions they pay less on Plan N and the whole thing reopens. The good news is that this is one of the cleanest comparisons in Medicare, because the federal government standardized it. Plan G is Plan G no matter whose name is on the envelope, and the difference between G and N is small enough to fit in a paragraph.
What actually differs between Plan G and Plan N
Medicare.gov publishes the benefit chart itself. Read across the Plan G column and the Plan N column and only two rows disagree:
| Benefit | Plan G | Plan N |
|---|---|---|
| Part B excess charge Only ever billed by a doctor who takes Medicare but doesn't accept assignment. | Covered 100% | Not covered |
| Part B coinsurance or copayment The ER copay goes away if you're admitted as an inpatient. | Covered 100% | Covered 100% except a copay of up to $20 for some office visits and up to $50 for an ER visit that doesn't end in admission |
| Everything else on the chart Part A deductible, Part A coinsurance plus 365 extra days, skilled nursing coinsurance, hospice, blood, foreign travel emergency at 80% — the same on both. | Identical | Identical |
Source: Medicare.gov: Compare Medigap Plan Benefits · copay amounts from CMS: Choosing a Medigap Policy — A Guide to Health Insurance for People with Medicare (2026).
The CMS guide states the copay rule in one sentence: "Plan N pays 100% of the Part B coinsurance. You must pay a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission." Note the words up to and some. The copay is a ceiling, not a flat charge, and it doesn't attach to every encounter — lab work and imaging generally aren't office visits.
And here's what people miss in the other direction: neither plan covers the Part B deductible. That's $283 in 2026, paid by G holders and N holders alike before either policy does anything on the Part B side. If you were told Plan G means you never see a bill, the deductible is the exception, and it comes first.
The break-even math
Because the benefits are standardized, the comparison collapses to one calculation: does the annual premium you save on N exceed what you'll hand over in copays? Multiply the monthly gap by twelve, divide by $20, and you have the number of capped office visits it takes to spend the savings back.
| If Plan N is cheaper by | You save | It takes about |
|---|---|---|
| $15 a month | $180 a year | 9 visits |
| $25 a month | $300 a year | 15 visits |
| $40 a month | $480 a year | 24 visits |
Illustration only — arithmetic on a hypothetical premium gap, not a quote. Real Medigap premiums vary by company, age, ZIP, and rating method; compare actual rates for the same plan letter before deciding.
If you'd rather not do it on paper, our Plan G vs. Plan N break-even calculator runs the same arithmetic against your own visit frequency.
Run your own number honestly. Not what you hope this year looks like — what last year actually looked like. Pull twelve months of explanation-of-benefits statements or your patient portal visit history and count. Most people are surprised in one direction or the other, and either surprise is useful.
Two adjustments to that count. Because the copay is capped rather than fixed, and because it doesn't apply to every service, your real copay total usually lands under the table's estimate — which tilts slightly toward N. And because an ER visit that doesn't end in an admission carries up to $50, a year with one bad Saturday night moves the line the other way.
The excess-charge question, and why Colorado is different
This is the line that makes people nervous about Plan N, so let's be precise about what it is. CMS defines it plainly: "If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the excess charge." Medicare's own handbook adds the ceiling — "in many cases, the charge can't be more than 15% above the Medicare-approved amount for non-participating health care providers. This amount is called the limiting charge."
Which means every doctor you might see falls into one of three buckets, and only the middle one produces an excess charge at all:
| Type of provider | What it means | Excess charge? |
|---|---|---|
| Participating | Accepts assignment — takes the Medicare-approved amount as payment in full. | None, ever |
| Non-participating | Still takes Medicare, but can bill above the approved amount. In many cases the charge can't exceed 15% above it — the limiting charge. | This is the excess charge |
| Opted out | Has left Medicare entirely and works by private contract. Medicare pays nothing, and neither does any Medigap plan. | Not an excess charge — a full private bill |
Sources: CMS: Choosing a Medigap Policy — A Guide to Health Insurance for People with Medicare (2026) · CMS: Medicare & You 2026 (official handbook).
Now the local wrinkle, and it's a genuine one. KFF's analysis of the CMS opt-out file puts Colorado among the highest opt-out states in the country at 2.3% of non-pediatric physicians, against roughly 1.2% nationally as of November 2024. Read that carefully before it scares you: opting out is the third bucket, not the second. A doctor who has opted out bills you privately and Medicare pays nothing — and neither Plan G nor Plan N helps you there. Buying G to protect yourself from Colorado's opt-out rate would be buying the wrong thing.
What the number does tell you is that in this state it's worth asking the question out loud at the front desk: do you accept Medicare assignment? Three answers, three very different bills. That's a two-minute phone call, and it's worth making it for any specialist you're referred to — including the ones you'll be sent to in Denver or Salt Lake for something St. Mary's or Community Hospital doesn't do here.
Bring three things and we can settle this in one sitting
(1) How many office visits you had in the last twelve months. (2) The actual premium quotes for the same letter from a few companies. (3) Your specialist list, including anyone out of town. Free, local, no pressure — and no, we don't need your Medicare number to talk.
Talk it through with Brian →What neither plan does
Worth stating flatly, because both letters get oversold:
- No drug coverage. Medigap doesn't include Part D. You buy a stand-alone drug plan alongside it, and in 2026 your out-of-pocket costs for covered Part D drugs stop at $2,100 for the year.
- No dental, vision, or hearing aids. Not under G, not under N, not under any lettered plan.
- No long-term care. Non-skilled custodial care in a nursing home is excluded from Medigap the same way it's excluded from Medicare.
- No out-of-pocket limit in the way Medicare Advantage has one — because with G or N there's very little left to cap. That's the point of them.
- No help with the Part B premium, which is $202.90 a month in 2026 and is on top of whatever your Medigap premium is.
One footnote that occasionally decides this whole thing: there's a high-deductible version of Plan G, where you pay Medicare-covered costs up to $2,950 in 2026 before the policy pays anything, in exchange for a much lower premium. It's a genuinely different animal from either G or N, it isn't offered by every company, and it suits a specific kind of person — healthy, disciplined, with the deductible sitting in cash. If the premium is what's driving you toward N, it belongs in the conversation.
Why the first choice matters more in Colorado
In some states you can move between Medigap letters every year around your birthday without answering a health question. Colorado is not one of them. Medicare.gov's rule governs here: outside your 6-month Medigap Open Enrollment Period or a guaranteed issue right, you generally have no federal right to switch, and the company can underwrite you and say no.
So the practical order of operations is: choose deliberately while you have the one-time right, and if you ever do move between G and N later, get the new policy issued before you cancel the old one. Not the same week — issued. We've covered what switching Medigap plans actually takes in Colorado separately, and it's the part of this decision people underestimate.
What Mesa County's health picture says about your visit count
The whole G-versus-N question turns on visit volume, and visit volume tracks what you're managing. Here's the real chronic-condition load among Mesa County adults:
Chronic-condition rates among Mesa County, Colorado adults
Source: CDC PLACES, 2023 — via the Medicare On Main Data Desk. Model-based prevalence among adults, 2023.
Diabetes at 8.1% and coronary heart disease at 5.2% describe a slice of the county that sees a physician on a schedule, not on a whim — quarterly A1c checks, a cardiology follow-up, a podiatry visit. For those households the copays add up quickly and Plan G's predictability tends to win. For the 26.6% managing blood pressure with a stable prescription and one annual visit, the arithmetic frequently points the other way. Same county, same two plans, opposite answers — which is why I don't have a house favorite.
How to decide this week
- Count last year's office visits. Actual count, from the portal or your statements.
- Get real quotes for the same letter from several companies. Medicare.gov's own guidance is that price is the only difference between same-letter policies — so shopping the letter is the whole game.
- Do the multiplication. Monthly gap times twelve, against your visit count times $20.
- Ask your doctors whether they accept assignment — especially specialists, and especially out-of-town ones.
- Ask about high-deductible Plan G if premium is the driver, so you're comparing all three, not two.
- Ask what the company's rate history looks like. A low first-year premium that jumps hard is a common and expensive surprise.
How we know all this: the Medicare On Main Data Desk frames every article with public data — here, Medicare.gov's standardized Medigap benefit chart, the CMS Medigap guide (publication 02110) for the Plan N copayment amounts and the definition of an excess charge, the Medicare & You 2026 handbook for the 15% limiting charge, the CMS 2026 cost figures published November 14, 2025, KFF's analysis of physician opt-out rates by state, and Mesa County health figures from CDC PLACES (2023). The break-even table is arithmetic on a hypothetical premium gap, clearly labeled, and is not a quote for any policy. This is education, not advice; confirm your plan, costs, and eligibility with a licensed agent or Medicare.gov. We take no payment from any carrier to feature a plan.
Frequently asked questions
What is the difference between Medigap Plan G and Plan N?
Three lines on Medicare's own benefit chart, and nothing else. Plan G covers Part B excess charges; Plan N doesn't. Plan G covers your Part B coinsurance in full; Plan N covers it except a copay of up to $20 for some office visits and up to $50 for an emergency room visit that doesn't result in being admitted. Neither one covers the Part B deductible, which is $283 in 2026. Everything else — the Part A deductible, Part A coinsurance plus 365 extra hospital days, skilled nursing coinsurance, hospice, blood, foreign travel emergency at 80% — is identical.
Is Medigap Plan N worth it?
It depends on one number you already know: how often you go to the doctor. Plan N trades a lower monthly premium for a copay of up to $20 on some office visits. If the premium gap is $25 a month, that's $300 a year, and it takes about 15 capped office visits to spend the savings back. Somebody managing two or three chronic conditions with quarterly specialist visits can get there. Somebody who sees a doctor twice a year usually doesn't. The second question is whether you value never seeing a bill — some people will pay $25 a month for that and be glad they did.
Does Plan N cover Part B excess charges?
No. Medicare.gov's benefit chart shows Part B excess charge as covered under Plan G and not covered under Plan N. An excess charge exists only when a provider takes Medicare but doesn't accept assignment — CMS defines it as the difference when "the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount." Medicare's own handbook adds that in many cases that charge can't be more than 15% above the approved amount. Most physicians accept assignment, so most Plan N holders never see one. It is still a real, uncapped-by-your-policy exposure, and it's the single line where Plan G buys you something Plan N doesn't.
Can I switch from Plan N to Plan G later?
You can always apply. Being accepted is the different question. Medicare.gov is direct about it: in most cases you don't have a right under federal law to switch Medigap policies unless you're inside your 6-month Medigap Open Enrollment Period or you have a guaranteed issue right. Any other time, the company can ask health questions and decline you. Colorado has no Medigap birthday rule, so there's no annual do-over here. That's why the choice you make when you first enroll carries more weight in Colorado than people expect — and why you never cancel the old policy until the new one is issued.
How much does Medigap Plan G cost in Colorado?
It varies by company, your age, your ZIP, and the rating method — and it moves every year, so a number quoted in an article is a number that will be wrong by the time you read it. What Medicare.gov will tell you is the part that matters: the benefits in each lettered plan are the same no matter who sells it, and "the price is the only difference between policies with the same plan letter sold by different companies." The Colorado Division of Insurance publishes a rate-comparison guide for exactly this reason. Compare the same letter across companies, then look at how often each has raised rates.
Does Medicare On Main charge to compare Plan G and Plan N?
No. Brian Penner is an independent, licensed advisor with 22+ years in insurance — paid by the carriers, not by you. We do not offer every plan available in your area. Call (970) 644-6954 or stop by the Grand Junction office at 627 24 1/2 Rd Ste H, Grand Junction, CO 81505, and bring your doctor list and how many visits you actually made last year. That's the whole analysis.
Sources
- Medicare.gov: Compare Medigap Plan Benefits — the standardized benefit chart showing Part B excess charge covered under G and not under N, and the $283 Part B deductible and $2,950 high-deductible threshold for 2026.
- CMS: Choosing a Medigap Policy — A Guide to Health Insurance for People with Medicare (2026) — the $20 office-visit and $50 emergency room copayment language, and the definition of an excess charge.
- CMS: Medicare & You 2026 (official handbook) — the 15% limiting charge for non-participating providers.
- Medicare.gov: Get Medigap Costs — price as the only difference between same-letter policies from different companies.
- Medicare.gov: Can I change my Medigap policy? — when you do and don't have a right to switch Medigap policies.
- KFF: How Many Physicians Have Opted Out of the Medicare Program? (November 2024 data) — Colorado's 2.3% physician opt-out rate against 1.2% nationally.
- CMS: 2026 Medicare Parts A & B Premiums and Deductibles (Nov 14, 2025) — the 2026 Part B premium ($202.90) and deductible ($283).
- Colorado Division of Insurance & Colorado SHIP — Medicare Supplement Insurance Policies in Colorado — Colorado's own Medicare supplement resources and rate comparison.
- CDC PLACES: Local Data for Better Health, County 2023 — Mesa County, Colorado chronic-condition prevalence (2023).
- Medicare Plan Compare (Medicare.gov) — the official tool for policies and plans available in your ZIP.
