Two people can hold the same Medigap plan, from the same insurer, in the same state, and pay premiums that drift hundreds of dollars apart over a decade. Neither is being overcharged. They bought policies priced by different methods, and nothing on the comparison page said so.
Start with the fact that makes this matter. Medicare's own guide is unambiguous: the benefits in each lettered plan are the same, no matter which insurance company sells it, and the premium is the only difference between policies with the same plan letter (opens in a new tab). Plan G from one company covers exactly what Plan G from another covers. There is no better Plan G.
So price is the whole comparison. And the guide warns there can be big differences in the premiums that different insurance companies charge for the same coverage.
The three pricing methods
Each insurance company decides how it will set the price for its policies, and a Medigap policy can be priced in one of three ways.
| Pricing method | How it works | What it means for you |
|---|---|---|
| Community-rated (also called no-age-rated) | Generally the same premium is charged to everyone, regardless of age or gender | Your premium is not based on your age. It may go up because of inflation and other factors, but not because of your age |
| Issue-age-rated (also called entry-age-rated) | The premium is based on the age you are when you buy the policy | Premiums are lower for people who buy at a younger age and will not change as you get older. Inflation and other factors can still raise them |
| Attained-age-rated | The premium is based on your current age, so it goes up as you get older | Premiums are low for younger buyers but go up as you age. They may be the least expensive at first, but they can eventually become the most expensive |
Source: Medicare, Choosing a Medigap Policy (opens in a new tab), Section 2.
The guide illustrates each with worked examples and then says, in its own footnote, that the amounts in the examples are not actual costs. That caution is worth repeating, because those illustrative figures circulate widely as though they were price lists. They are there to show the shape of the curve, not the level of it.
Attained-age is cheapest at 65, and that is exactly the problem
Read the third row again. An attained-age-rated policy is the one that looks best when you are shopping, because at 65 it is the cheapest of the three. It is also the only one with your age built into it as a recurring escalator.
The other two rise for inflation. Attained-age rises for inflation and for the fact that another year has passed. Those are separate increases, arriving together on the same renewal notice, and the notice does not usually separate them.
The part that makes this hard to undo
If attained-age pricing turns out badly, the obvious response is to switch to a community-rated policy later. That option may not be there.
Your Medigap open enrollment period runs six months from the first month you have Part B and are 65 or older, and during it an insurer cannot refuse you or charge more because of your health. Once it closes, it does not reopen — and Medicare Open Enrollment in the autumn is not a substitute for it. The full mechanics are in the Medigap window that is six months long and only opens once.
Outside that window, and without a guaranteed issue right, Medicare states plainly that an insurer may use medical underwriting or charge a different premium. So the decision about pricing method is made at the point where you have the most protection, and revisited at the point where you have the least. That asymmetry is the real reason to ask the question up front.
What else moves the premium
Pricing method is the structural factor. Several others sit on top, and Medicare lists them:
- Discounts. Insurers may offer them for women, non-smokers or married people; for paying yearly; for paying by electronic funds transfer; or for holding multiple policies.
- Medical underwriting, where you do not have a guaranteed issue right and are not in your open enrollment period.
- Medicare SELECT. A type of Medigap policy that requires you to use hospitals, and in some cases doctors, within its network for full benefits. The premium is generally lower in exchange.
- A high-deductible option on Plans F and G. Buy one and you pay the first $2,950 in 2026 of deductibles, copayments and coinsurance for covered services Medicare does not pay, before the policy pays anything. A separate $250 annual deductible applies to foreign travel emergency care.
And the baseline: Medicare says premium amounts typically increase each year, whichever method applies. A policy that has not risen in three years is worth asking about, which is why the guide suggests asking exactly that.
The questions Medicare tells you to ask
The guide includes a list of questions for the insurer. Three of them decide what this policy costs you over its life, and none can be answered from a comparison table:
- "Do you price this Medigap policy by using community-rating, issue-age-rating, or attained-age-rating?"
- "I'm ___ years old. What would my premium be under this Medigap policy?" — and for an attained-age policy, "How frequently does the premium increase due to my age?"
- "Has the premium for this Medigap policy increased in the last 3 years due to inflation or other reasons?" If yes, ask by how much.
Actual Medigap prices are not published in the guide. You get them by calling insurers directly, or through your State Health Insurance Assistance Program, which is free and is listed at shiphelp.org (opens in a new tab). Medicare also lists which companies sell Medigap policies in your area.
Where this sits against the other decision
Pricing method only matters if Medigap is the route you are taking. The prior question — Original Medicare with a Medigap policy, or Medicare Advantage — is a different trade with a different irreversibility to it, and it is set out in Original Medicare or Medicare Advantage for 2027. What a Medigap policy sits on top of is covered in what Medicare costs, and what has and has not been published for next year is in Medicare in 2027.
Before you buy
- Pick the plan letter first. Benefits are standardized, so this is a coverage decision, not a shopping decision.
- Then compare the same letter across companies. Plan G against Plan G, never Plan G against Plan N.
- Ask which of the three pricing methods applies, in those words.
- If it is attained-age, ask how often the age increase applies and what it has been.
- Ask what the premium has done over the last three years.
- Ask about discounts, which can be substantial and are rarely volunteered.
- Check your six-month window before anything else. It is the only period in which your health cannot be priced.
Sources
- Medicare: Choosing a Medigap Policy (CMS Publication 02110) (opens in a new tab)
- Medicare.gov: Get Medigap costs (opens in a new tab)
- Medicare.gov: Medigap basics (opens in a new tab)
- Medicare.gov: When can I buy a Medigap policy? (opens in a new tab)
- Medicare.gov: Find a Medigap policy in your area (opens in a new tab)
- State Health Insurance Assistance Programs (opens in a new tab)
This article is general information for a United States audience. It is not insurance, medical or financial advice, and it does not recommend a plan, a company or a pricing method. Medigap availability, the pricing methods insurers may use, and the additional protections that apply vary by state, and federal rules can change. Only your own policy document and your state's rules govern what you pay. Confirm the position that applies to you on Medicare.gov or with your State Health Insurance Assistance Program before relying on any of this. Last reviewed 3 November 2026.
