Medigap Plan G vs. Plan N: What’s the Difference for Houston Retirees in 2026?

If you have narrowed your Medicare Supplement search to Plan G versus Plan N, here is the difference in one breath: both plans cover the same big-ticket Medicare gaps — Part A hospital costs, the Part A deductible, skilled-nursing coinsurance, and 20% Part B coinsurance — but Plan G also pays your Part B excess charges and has no office or emergency-room copays, while Plan N drops excess-charge coverage and asks you to pay a copay of up to $20 for some office visits and up to $50 for emergency-room visits that don’t lead to an admission. In exchange, Plan N usually carries a lower monthly premium. Neither plan covers the Part B deductible — that one is on you. Everything else in this decision comes down to the trade-off between a steadier premium (Plan G) and lower fixed cost with a bit more variability (Plan N).

For a Houston retiree, that trade-off is not abstract. Texas is one of the states that still permits Part B excess charges, so where you live changes how much the “no excess-charge coverage” line on Plan N actually matters. This guide walks through exactly what each plan covers, how the premium math works, why Texas geography matters for Plan N holders, and a worked break-even example using verified 2026 numbers. Wise Insurance Agency sits with North Houston and South Houston retirees at the kitchen table on this exact question every week — and the honest answer is that the “right” plan depends on your doctors, your budget rhythm, and how you feel about a surprise line on a bill.

What is Medigap, and why is a Plan G a Plan G everywhere?

Medigap — also called Medicare Supplement Insurance — is a private policy that pays the “gaps” Original Medicare leaves behind: the deductibles, coinsurance, and copayments you would otherwise owe out of pocket under Medicare Part A (hospital) and Part B (medical). You keep Original Medicare as your primary coverage; the Medigap policy is secondary and picks up its assigned share of what’s left after Medicare pays.

The single most important thing to understand before comparing companies is this: Medigap plans are federally standardized. Since 1992, the benefits inside each lettered plan (A, B, D, G, K, L, M, N, and the high-deductible versions) have been set by federal law. That means a Plan G is a Plan G no matter which insurance company sells it, and a Plan N is a Plan N everywhere. One company’s Plan G cannot cover more or fewer core benefits than another company’s Plan G. What differs between companies is the monthly premium, the financial strength of the carrier, customer service, and how they raise rates over time — not the benefits on paper. The federal benefit grid is published on Medicare.gov’s Compare Medigap Plan Benefits page.

That standardization is why the Plan G vs. Plan N decision is so clean: you are not comparing dozens of fine-print coverage differences. You are comparing two fixed benefit sets, the premiums different companies charge for each, and how those benefit sets interact with your own health habits and your Houston providers. For the bigger picture of how Medigap fits with the rest of your coverage, see our Medicare Supplement Plans overview and our broader Medicare hub. Medigap does not include prescription drug coverage, so most people on a Plan G or Plan N also enroll in a stand-alone Part D drug plan.

Exactly what Plan G covers — and the one thing it doesn’t

Plan G covers nearly every gap Original Medicare leaves, with one exception: the annual Part B deductible. Once you pay that deductible yourself ($283 in 2026), Plan G is one of the most comprehensive Medigap plans available to people newly eligible for Medicare. Here is the full list of what a standardized Plan G pays:

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up — paid in full.
• Part B coinsurance or copayment — the 20% of doctor and outpatient costs Medicare leaves to you — paid in full, with no per-visit copay.
• Part A deductible — the inpatient hospital deductible ($1,676 per benefit period in 2025; confirm the 2026 figure with your plan) — paid in full.
• Skilled nursing facility care coinsurance for days 21–100 — paid in full.
• Part A hospice care coinsurance or copayment — paid in full.
• First 3 pints of blood each year — paid in full.
• Part B excess charges — paid in full. This is the line that separates Plan G from Plan N.
• Foreign travel emergency care — 80% of billed charges for medically necessary emergency care abroad, after a $250 annual deductible, up to a $50,000 lifetime maximum.

The one core gap Plan G does not cover is the Part B deductible. By federal law, no Medigap plan first sold to someone who became eligible for Medicare on or after January 1, 2020 can pay the Part B deductible — that’s why Plan F (which did cover it) is closed to newly eligible enrollees, and Plan G has become the comprehensive plan of choice. In 2026, you pay the first $283 of Part B-covered costs yourself; after that, Plan G’s Part B benefits take over.

The standout feature is Part B excess charge coverage. If a Houston doctor doesn’t accept Medicare “assignment,” they can legally bill more than the Medicare-approved amount (more on the cap below). Plan G absorbs that extra charge for you; Plan N does not. We cover the practical Texas angle in the excess-charges section.

Exactly what Plan N covers — the copays and the excess-charge gap

Plan N covers the same benefits as Plan G with two exceptions: it does not pay Part B excess charges, and it asks you to pay small copays at the point of care. Everything else — Part A hospital costs and the Part A deductible, skilled-nursing coinsurance, hospice coinsurance, the first 3 pints of blood, and foreign travel emergency at 80% — is identical to Plan G. Like Plan G, Plan N does not cover the Part B deductible.

What Plan N changes:

• Office-visit copay of up to $20. For some office visits, Plan N has you pay a copayment of up to $20 instead of covering 100% of the Part B coinsurance the way Plan G does. This is a fixed dollar amount, not a percentage.
• Emergency-room copay of up to $50. For an ER visit that does not result in an inpatient admission, Plan N has you pay up to $50. If you are admitted, the ER copay is typically waived and the visit rolls into your covered inpatient stay.
• No Part B excess charge coverage. If a non-participating provider bills above the Medicare-approved amount, you pay that excess yourself under Plan N. Under Plan G, the plan would have paid it.

For the great majority of Part B coinsurance — outpatient surgery, lab work, imaging, specialist consultations beyond the office copay — Plan N still pays your 20% share, exactly like Plan G. The copays are deliberately modest and apply mainly to routine office and non-admitted ER visits. Whether the lower premium more than offsets those copays is the heart of the decision, and we break it down in the break-even example. The official Plan N copay maximums of up to $20 (office) and up to $50 (ER, non-admitted) are stated on Medicare.gov’s Medigap benefits comparison.

Plan G vs. Plan N: the side-by-side benefit grid

Read the grid top to bottom and the pattern is clear: the only three rows where Plan G and Plan N differ are the Part B copays, Part B excess charges, and the resulting premium. Six of the nine benefit categories are byte-for-byte identical.

The premium trade-off: lower monthly cost vs. more variability

Plan N almost always carries a lower monthly premium than Plan G — that lower premium is precisely what you are buying when you accept the copays and the excess-charge risk. There is no free lunch in standardized insurance: the benefit Plan N gives up (excess-charge coverage) and the costs it shifts to you (the copays) are the reason its premium is lower. The question is whether the annual premium difference is larger or smaller than the copays and excess charges you would actually incur in a year.

Premiums are not standardized — they vary by company, your age, ZIP code, tobacco use, and how the carrier prices (community-rated, issue-age-rated, or attained-age-rated). Because of that, we will not quote a specific Houston premium here; rates change and differ by carrier, and the only accurate number is the one quoted for your exact profile. What is consistent across the market is the shape of the trade-off:

• Plan G = higher fixed monthly premium, near-zero surprise at the point of care. You pay the Part B deductible once a year and essentially nothing else for Part B-covered services.
• Plan N = lower fixed monthly premium, plus small variable costs (the copays) and a tail risk (excess charges) that depends on which providers you see.

The conceptual chart below shows how total annual cost builds for each plan as you add doctor visits. Plan N starts lower (the premium gap) but its line rises with each copay; Plan G stays flatter. Where the two lines cross is your personal break-even point.

Part B excess charges in Texas — why Houston geography matters for Plan N

A Part B excess charge is the extra amount a provider can bill when they accept Medicare but do not accept “assignment” — and Texas is one of the states that still allows it. When a doctor accepts Medicare assignment, they agree to accept the Medicare-approved amount as full payment. A “non-participating” provider who does not accept assignment can bill you up to the federal limiting charge, which is 15% above the Medicare-approved amount. That 15% gap is the excess charge.

This is where the Plan G vs. Plan N decision stops being national and becomes a Houston decision. Eight states ban Part B excess charges entirely — Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. In those states, the excess-charge difference between Plan G and Plan N is moot, because no provider can bill the excess in the first place. Texas is not one of those eight states. A Houston-area provider who does not accept assignment can legally bill the 15% excess, and a Plan N holder would owe it out of pocket; a Plan G holder would not.

How worried should a Houston Plan N shopper actually be? The honest answer is: it depends on your providers, and it is checkable. The large Houston health systems and the great majority of primary-care physicians accept Medicare assignment, which means no excess charge applies regardless of plan. Where excess charges tend to surface is with certain independent specialists. The practical move is to confirm assignment status for the doctors you actually see before you choose Plan N. You can check whether a provider accepts Medicare as full payment using the guidance on Medicare.gov’s provider-payment page, and our team will help you run that check for your specific Houston physicians.

One reassurance baked into federal law: even a non-participating provider cannot bill more than the 15% limiting charge, and you are never legally responsible for amounts above it. So the excess-charge exposure on Plan N is capped, not open-ended — it is at most 15% of the Medicare-approved amount on services from a non-assignment provider.

A worked break-even example for a Houston retiree

The break-even is the point where Plan N’s annual premium savings exactly equal the copays and excess charges you incur — below it Plan N costs less for the year, above it Plan G does. Because premiums differ by carrier and ZIP, we will work this with an illustrative premium gap rather than a quoted rate. The logic transfers to whatever real numbers your quote shows.

Suppose, for illustration only, that for your age and Houston ZIP a Plan N premium runs $30 per month lower than a comparable Plan G. That is $360 per year of premium savings on Plan N. Now you spend that $360 cushion down with Plan N’s copays and any excess charges:

• Each office visit with a copay costs you up to $20 on Plan N (and $0 on Plan G). At $20 each, 18 such visits would consume the full $360.
• Each non-admitted ER visit costs up to $50 on Plan N. Two ER visits ($100) plus 13 office visits ($260) would also reach $360.
• Excess charges only appear if you see a non-participating provider in Texas. If all your providers accept assignment, this column is $0 and Plan N keeps more of its premium advantage. If a specialist bills the 15% excess on a few procedures, that erodes the advantage faster.

So in this illustration, a healthy Houston retiree who sees the doctor a handful of times a year, uses providers who accept assignment, and rarely visits the ER would likely come out ahead on Plan N — the premium savings outrun the modest copays. A retiree who sees specialists frequently, has unplanned ER visits, or uses non-participating providers could spend through the $360 and be better off on Plan G’s predictability. The sample annual-cost scenarios below make that concrete.

The numbers above assume a $30/month gap purely to show the mechanics; your real gap could be larger or smaller, which moves the break-even. The pattern, though, is durable: light, assignment-only users tend to win with Plan N; heavy users and those exposed to excess charges tend to win with Plan G. Running this with your actual quoted premiums and your real visit pattern is exactly the calculation our agents do for Houston clients.

Who tends to fit Plan G, who tends to fit Plan N

There is no plan that is right for everyone — the fit depends on how predictable you want your costs to be and how you use care. After running this comparison with hundreds of Houston retirees, some patterns hold up:

Plan G tends to fit you if…

• You want the most predictable possible budget — one annual Part B deductible and essentially nothing else for covered Part B services.
• You see specialists often or expect frequent office visits, where Plan N copays would add up.
• You see, or might be referred to, providers who don’t accept Medicare assignment — the Texas excess-charge exposure makes Plan G’s full excess coverage valuable.
• You travel and value the simplicity of zero point-of-care copays.

Plan N tends to fit you if…

• You are a relatively light user of care — a few office visits a year, rare ER trips.
• Your doctors accept Medicare assignment (which you can confirm before enrolling), neutralizing most excess-charge risk.
• You want a lower monthly premium and are comfortable paying small, capped copays when you do use care.
• You’d rather keep more money in your pocket month to month and accept a bit of variability.

Notice that none of this declares one plan superior in the abstract. A frequent-flyer at the cardiologist and a healthy walker who sees the doctor twice a year can look at the identical premium quote and reach opposite, equally correct conclusions. That is why we model it on your numbers rather than recommending a plan letter on reputation. To see how these plans sit alongside your other Medicare choices, our Medicare Plans page maps the options, and our Medicare Advantage page covers the alternative path some retirees weigh against Medigap.

High-Deductible Plan G, and how Texas Medigap timing works

Before you lock in standard Plan G or Plan N, know that a third option exists: High-Deductible Plan G (HDG). It carries the same benefit structure as standard Plan G, but you pay a much lower monthly premium in exchange for meeting a high annual deductible first — $2,800 in 2026 — before the plan begins paying. Once you reach that deductible, HDG covers the same gaps standard Plan G does. It can fit budget-conscious retirees who want catastrophic-style protection with a low premium and are comfortable carrying more first-dollar risk. We cover it in depth on our High-Deductible Medigap Plans page; it deserves a side-by-side look next to standard G and N before you decide.

How Texas Medigap timing and underwriting work

When you can buy Plan G or Plan N without a health review is governed by federal and Texas rules, and the timing matters as much as the plan choice:

• The Medigap Open Enrollment Period is your one guaranteed window. It is a one-time, six-month period that starts the month you are 65 or older and enrolled in Medicare Part B. During it, you have a guaranteed issue right: a company must sell you any Medigap plan it offers, cannot turn you down for health reasons, and cannot charge you more because of your health history.
• After that window closes, medical underwriting generally applies. Outside of the Open Enrollment Period or a specific guaranteed-issue situation, a Texas insurer can ask health questions and decline or surcharge an application. That makes switching from Plan G to Plan N (or between carriers) later potentially harder, depending on your health.
• Texas does not have a Medigap “birthday rule.” A handful of states (such as California and Oregon) give enrollees an annual window to switch Medigap plans without underwriting around their birthday. Texas is not one of them, so do not count on an annual no-underwriting switch — plan your initial choice carefully.

The practical takeaway: your six-month Medigap Open Enrollment Period is the moment you have the most leverage and the fewest barriers. Choosing between Plan G, Plan N, and HDG during that window — when you cannot be turned down — is very different from trying to change later under underwriting. For the eligibility timeline, see our Medicare Eligibility page, and reach out through Contact Us or Book an Appointment so we can map your window before it closes.

Frequently asked questions

Wise Insurance Agency is a licensed insurance agency in the State of Texas. The information here is general guidance and not a substitute for plan-specific advice. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Plan benefits described reflect federally standardized Medigap benefit rules and the 2026 Part B deductible and High-Deductible Plan G deductible as published by CMS and Medicare.gov as of the date this article was written; premiums vary by carrier and are not standardized. Verify current rules and rates with a licensed agent before making any election.