Plan G vs N vs Advantage — the real math of Medicare's biggest decision
| Plan G | Plan N | Advantage |
|---|
At 65, American healthcare offers one genuinely irreversible fork: Original Medicare + a Medigap supplement (any doctor, near-zero bills, higher premiums) versus Medicare Advantage (low premiums, networks, copays, prior authorizations). The trap is that the choice is one-way for many people — Medigap's guaranteed acceptance lasts only six months from Part B enrollment; afterwards, health underwriting can bar the return. This comparator prices the leading Medigap plans (G and N) against a typical Advantage plan at your expected usage, so the fork gets chosen with numbers.
| Plan G | Plan N | Advantage (typical) | |
|---|---|---|---|
| Premium (65, average state) | ~$140–175/mo | ~$105–135/mo | $0–60/mo |
| Your exposure when sick | $257/yr (Part B deductible), then $0 | Deductible + $20 office / $50 ER copays | Copays everything; $4,000–8,850 max out-of-pocket |
| Networks / referrals | None — any Medicare provider nationwide | HMO/PPO networks, prior authorization common | |
(Plan F — G plus the Part B deductible — closed to new 65-year-olds in 2020; Plan G is its successor. High-deductible G exists at ~$50/mo with a ~$2,900 deductible for the premium-averse.)
N's ~$35–45/mo discount buys you $20/$50 copays and exposure to Part B "excess charges" (the ~1% of doctors who bill 15% over Medicare rates — banned in 8 states). Light users net ahead on N; frequent-visit users and excess-charge states favor G. Either way, shop carriers hard: the plans are federally standardized — G is G — so the only differences are price (2× spreads for identical coverage!) and the insurer's rate-increase history. Attained-age vs issue-age vs community-rated pricing structures matter more than the year-one premium.
All paths pay the Part B premium ($185/mo, income-adjusted via IRMAA — where Roth conversions two years prior bite). Original Medicare needs a separate Part D drug plan ($0–50/mo) and offers no dental/vision — see the Dental and Vision tools for that math. Advantage bundles drugs and extras — part of its healthy-year appeal.
Insurers receive ~$1,000+/month from Medicare per enrollee — healthy enrollees are profitable, hence the marketing (and the free gym memberships). $0 premium ≠ $0 cost: the max out-of-pocket and network rules are the actual price.
Starting the month Part B begins (usually at 65), insurers must issue any Medigap plan at standard rates — no health questions. After it closes, underwriting applies except in guaranteed-issue situations (plan exits, moves) and a few always-open states. It's the most consequential deadline in retirement healthcare.
That's precisely what underwriting prevents — a diagnosed condition means denial or loaded rates in most states. Exception: a 12-month 'trial right' exists if Advantage was your FIRST choice at 65. The one-way door is the system's defining feature.
Marketing costs, target demographics and rate-increase strategies. Same coverage, wildly different premiums and trajectories. Buy from a broker quoting 10+ carriers, and ask for each carrier's 5-year rate-increase history — the cheap plan that hikes 10%/yr isn't cheap.
Original Medicare + Medigap needs a standalone Part D plan (shop yearly at medicare.gov — plans reprice drugs annually and loyalty costs hundreds). Advantage usually embeds drug coverage. Either way the $2,000 annual Part D out-of-pocket cap (2025+) tamed the worst-case.
No, no, no, and no. Dental/vision are separate policies or cash; long-term care is its own planning problem (see the LTC tool). Advantage plans' dental extras are real but capped ($1,000–2,000/yr typically) — a benefit, not a plan.
Yes — every figure computes locally in your browser.
Choose the system inside your window like the irreversible decision it mostly is: certainty-and-access (Medigap) versus cheap-years-and-networks (Advantage). The comparator's heavy-usage run is the one to trust — insurance decisions are graded in the bad years.