Medicare Supplement Plan N Copay Break-Even: Is Lower Premium Worth It?
Medicare Supplement Plan N Copay Break-Even: Is Lower Premium Worth It?
Plan N offers lower monthly premiums than Plan G, but requires copays for doctor and ER visits. Finding your break-even point helps you choose the right plan.
Quick Answer
Choose Plan N if: Your annual copays are less than your premium savings Choose Plan G if: Your annual copays exceed your premium savings
Break-Even Formula:
Break-Even Visits = (Plan G Premium - Plan N Premium) × 12 ÷ $20Example: If Plan G costs $40 more per month, you break even at 24 office visits per year.
Use our Medicare Supplement Penalty Calculator to compare total costs for both plans.
Detailed Guidance
Plan N Copays Explained
Plan N Copay Structure:
- Office visits: $20 copay
- ER visits: $50 copay (waived if admitted)
- Part B deductible: $240 (you pay, same as Plan G)
- Part B excess charges: YOU pay (Plan G covers)
Plan G Copay Structure:
- Office visits: $0 copay
- ER visits: $0 copay
- Part B deductible: $240 (you pay)
- Part B excess charges: $0 (Plan G covers)
Premium Difference Analysis
Average Monthly Premiums (Age 65, Non-Tobacco):
- Plan G: $145/month
- Plan N: $105/month
- Monthly savings: $40
- Annual savings: $480
Break-Even Calculator
How Many Doctor Visits Make Plan G Worth It?
Annual Premium Savings (Plan N) = Monthly Savings × 12
Annual Copay Cost (Plan N) = Office Visits × $20 + ER Visits × $50
If Copay Cost < Premium Savings → Plan N wins
If Copay Cost > Premium Savings → Plan G winsBreak-Even Examples:
| Annual Doctor Visits | Plan N Copays | Premium Savings | Net Savings (Plan N) | Winner |
|---|---|---|---|---|
| 6 | $120 | $480 | +$360 | Plan N |
| 12 | $240 | $480 | +$240 | Plan N |
| 18 | $360 | $480 | +$120 | Plan N |
| 24 | $480 | $480 | $0 | Tie |
| 30 | $600 | $480 | -$120 | Plan G |
| 36 | $720 | $480 | -$240 | Plan G |
With 1 ER Visit (Not Admitted): Add $50 to Plan N copays. Break-even drops to 21-22 office visits.
The Hidden Cost: Excess Charges
What Are Excess Charges?
When a doctor doesn’t accept Medicare assignment, they can charge up to 15% above the Medicare-approved amount.
Impact on Plan N vs Plan G:
| Scenario | Plan G Cost | Plan N Cost | Difference |
|---|---|---|---|
| $200 specialist visit (assignment) | $0 | $20 copay | Plan N saves $20 |
| $200 specialist + 15% excess | $0 (covered) | $20 copay + $30 excess | Plan G saves $10 |
| $1,000 procedure + 15% excess | $0 (covered) | $20 copay + $150 excess | Plan G saves $170 |
Key Risk: If your doctors don’t accept Medicare assignment, Plan N excess charges can quickly eliminate premium savings.
Real-World Scenarios
Scenario 1: Healthy Senior, Occasional Care
- 6 doctor visits per year
- 0 ER visits
- All doctors accept assignment
- Plan N cost: $105 × 12 + (6 × $20) = $1,380
- Plan G cost: $145 × 12 = $1,740
- Winner: Plan N saves $360/year
Scenario 2: Chronic Condition, Regular Care
- 24 doctor visits per year
- 1 ER visit (not admitted)
- Some specialists charge excess
- Plan N cost: $105 × 12 + (24 × $20) + $50 + $100 excess = $1,790
- Plan G cost: $145 × 12 = $1,740
- Winner: Plan G saves $50/year
Scenario 3: High Healthcare User
- 36 doctor visits per year
- 2 ER visits (1 admitted)
- Multiple specialists, some excess charges
- Plan N cost: $105 × 12 + (36 × $20) + $50 + $300 excess = $2,410
- Plan G cost: $145 × 12 = $1,740
- Winner: Plan G saves $670/year
Who Should Choose Plan N?
Plan N Is Best For:
- Healthy individuals with few doctor visits (under 15/year)
- Those whose doctors all accept Medicare assignment
- People who want lower monthly premiums
- Budget-conscious enrollees who can absorb copays
- Those comfortable with some cost-sharing
Plan N Makes Sense If:
- You rarely see specialists
- You don’t expect hospitalizations
- Your doctors participate in Medicare fully
- You want to minimize monthly premium burden
- You can handle variable out-of-pocket costs
Who Should Choose Plan G?
Plan G Is Best For:
- Frequent doctor visitors (15+ visits/year)
- Those with chronic conditions
- People who see multiple specialists
- Individuals concerned about excess charges
- Anyone who wants predictable costs
- Those who value comprehensive coverage
Plan G Makes Sense If:
- You have ongoing health issues
- You see specialists who may not accept assignment
- You want zero copays for office/ER visits
- Predictable costs matter more than lowest premium
- You can afford higher monthly premium
Plan Selection Checklist
- Count your average annual doctor visits
- Check if your doctors accept Medicare assignment
- Get quotes for Plan G and Plan N in your area
- Calculate premium difference × 12 = annual savings
- Divide annual savings by $20 = break-even visits
- Add expected ER visits ($50 each, unless admitted)
- Factor in excess charge risk (ask doctors)
- Consider your health trajectory
- Use our calculator for precise numbers
Frequently Asked Questions
Does Plan N cover the Part B deductible?
No. Both Plan G and Plan N require you to pay the Part B deductible ($240 in 2026). Neither plan covers this.
Can excess charges really add up that much?
Yes. If you have a $10,000 procedure and the doctor charges 15% excess, you pay $1,500 out-of-pocket with Plan N. Plan G covers this entirely.
Do all doctors charge excess charges?
No. Many doctors accept Medicare assignment and don’t charge excess. Ask your doctors directly before choosing Plan N.
What if my health changes and I need more care?
Once outside Open Enrollment, switching from Plan N to Plan G requires medical underwriting. You may be denied coverage if your health has declined.
Is Plan N worth it for a healthy 65-year-old?
Often yes. If you’re healthy and see doctors less than 15 times per year, Plan N typically saves $200-500 annually. Just verify your doctors accept Medicare assignment.