Medigap Plan N Excess Charges by State in 2026
November 7, 2026
Medigap Plan N does not pay Medicare Part B excess charges, the extra amount a doctor can bill above the Medicare-approved amount. This gap only matters if your doctor does not accept Medicare assignment, meaning they have not agreed to accept Medicare's approved amount as full payment. In most states, that doctor can legally bill you up to 15% more than Medicare's approved amount, and Plan N leaves you to pay that difference yourself.
A handful of states limit or ban this practice through their own insurance rules, which changes how much Plan N's coverage gap matters depending on where you live and get care.
Quick Answer
Medigap Plan N leaves you responsible for Medicare Part B excess charges, up to 15% above the Medicare-approved amount, when a provider does not accept Medicare assignment. Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont have state insurance rules that limit or prohibit excess charges, so this Plan N gap has little practical effect for care received in those states. Everywhere elseMedigap Plan G covers excess charges in full, which is the main cost tradeoff between the two plans.
What a Medicare Excess Charge Actually Is
Medicare sets an approved amount for each covered service. A doctor who accepts Medicare assignment agrees to take that approved amount as full payment and cannot bill you more. A doctor who does not accept assignment, sometimes called a non-participating provider, can charge up to 15% above the Medicare-approved amount under federal rules. That extra 15% is the excess charge, and it is billed directly to you, not to Medicare or your Medigap plan.
Most doctors who treat Medicare patients do accept assignment, so excess charges come up less often than people expect. They are more likely with certain specialists or in areas with fewer Medicare-participating providers nearby.
Why Plan N Skips This Coverage and Plan G Doesn't
Medigap plans are standardized, so every insurer's Plan N covers the same set of benefits, and every insurer's Plan G covers the same broader set. Plan G includes full coverage for Part B excess charges, while Plan N does not, which is one reason Plan N typically carries a lower monthly premium. If you mostly see providers who accept assignment, that gap may never cost you anything. If you see specialists who bill above the Medicare-approved amount, or you travel to states without excess charge limits, the gap becomes a real out-of-pocket risk.
Plan G vs. Plan N: Excess Charge Coverage
| Feature | RecommendedPlan G | Plan N |
|---|---|---|
| Covers Part B excess charges | Yes, in full | No |
| Part B copays for office visits | Fully covered | Up to $20 copay may apply |
| Typical monthly premium | Generally higher | Generally lower |
| Best fit if provider doesn't accept assignment | Stronger protection | Out-of-pocket risk |
States That Limit or Prohibit Excess Charges in 2026
State insurance regulations in the following states limit or prohibit Medicare excess charges for providers practicing there, according to widely cited Medigap guidance used by insurance agents and consumer resources:
- Connecticut
- Massachusetts
- Minnesota
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Vermont
In these states, Plan N's lack of excess charge coverage generally has little practical effect, because providers are restricted from billing above the Medicare-approved amount in the first place. If you live in or regularly receive care in any other state, that protection does not apply, and a non-participating provider can still bill you the full 15% permitted under federal rules.
Confirm Current State Rules Before You Decide
State insurance rules can change, and protections may apply only to certain provider types or specific billing situations. Before choosing a plan based on your state's excess charge limits, confirm the current rule with your state's department of insurance or the National Association of Insurance Commissioners (NAIC), a group representing state insurance regulators.
How to Check if Excess Charges Could Affect You
- Ask your doctor's billing office whether they accept Medicare assignment
- Check whether your state is one of the eight that limits excess charges
- Review whether you regularly see specialists who might not accept assignment
- Factor in whether you travel to other states for care or live part-time elsewhere
- Compare the Plan G premium difference against your realistic excess charge risk
Key Takeaway
Plan N's excess charge gap is most relevant if you live outside the eight states with protections and regularly see providers who don't accept Medicare assignment. If that describes your situationMedigap Plan G closes the gap at a higher premium. If it doesn't, Plan N's lower premium may be the better value.
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Frequently Asked Questions
Yes. Plan G covers Medicare Part B excess charges in full, which is the main benefit difference between Plan G and Plan N.
A provider who does not accept Medicare assignment can bill up to 15% more than the Medicare-approved amount. This is the federal limiting charge, and it applies on top of your regular Part B coinsurance.
Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont have state rules that limit or prohibit excess charges for providers practicing in those states. Confirm current rules with your state insurance department, since regulations can change.
It depends on your providers and location. If you live in a state with excess charge protections and your doctors accept assignment, Plan N's lower premium may be the better fit. If you see providers who don't accept assignment or live outside those states, Plan G's added coverage may be worth the higher premium. See how to compare Medigap plans side by side for a fuller cost comparison.