Medicare Supplement

How California prices the same Medigap letter differently

In Riverside, shoppers looking at Medicare Supplement Insurance — better known as Medigap — often ask a fair question: if Plan G is Plan G everywhere, why do prices and offers vary so much from one insurer to the next? The coverage is the same by law, but how each insurer builds its price, raises it over time, and decides whether to accept you is not. Here is what to look at when you line up the same plan letter across companies.

Medicare SupplementRiverside, CA

The coverage is standardized — the company is not

Medigap plans sold to people newly eligible for Medicare today are labeled A, B, D, G, G-HD, K, L, M and N. (Plans C and F are only available if you were eligible for Medicare before January 1, 2020.) By federal rule, a Plan G from one insurer pays the same benefits as a Plan G from any other insurer selling in Riverside County. What changes from company to company is the price tag, how that price will move over time, what discounts apply, and how the insurer will treat your application if you are outside a guaranteed-issue window.

That is the honest starting point for any comparison: same letter, same coverage; different business practices.

How insurers set the price: three methods

California allows three pricing structures for Medigap, and knowing which one an insurer uses matters as much as today's premium.

• Community-rated (no-age-rated). Everyone with the same plan pays the same base premium, regardless of age. Premiums can still rise with inflation and claims costs.
• Issue-age-rated. Your premium is based on your age when you first buy the policy. It does not go up simply because you get older, though inflation and claims costs still apply.
• Attained-age-rated. Your premium is based on your current age and rises as you age, in addition to inflation and claims increases.

Two insurers can quote similar prices at age 65 and look very different at age 78. Ask each insurer, in writing, which method they use for the plan letter you are considering.

Rate history is the quiet tiebreaker

Because standardized coverage is identical, an insurer's history of rate increases is one of the few real differentiators. California's Department of Insurance publishes a Medigap rate guide that shows premium ranges by plan letter and, in many cases, historical increases. Reviewing several years of increases for the same plan letter across companies gives you a sense of which insurers have kept increases modest and which have not. No one can promise future rates, but a track record is data.

Household discounts and other price levers

Many — not all — California Medigap insurers offer a household discount when two adults in the same home each buy a policy from that company. The size of the discount and the eligibility rules vary. Some insurers count roommates; others require a spouse or domestic partner. Ask about:

• Household or spousal discounts
• Payment-method discounts (for example, electronic funds transfer)
• Any first-year enrollment discount and what happens when it ends

A first-year discount that disappears in year two can make a plan look cheaper on paper than it really is over time.

Underwriting: when insurers can say no

During your six-month Medigap Open Enrollment Period — which starts the month you are 65 or older and enrolled in Part B — insurers must sell you any Medigap policy they offer, at their best available rate, regardless of your health. That is guaranteed-issue.

Outside that window, California insurers generally can use medical underwriting, meaning they can decline you or charge more based on health. California does offer a "birthday rule": each year, for a limited window around your birthday, you can switch to a Medigap policy with equal or lesser benefits from any insurer without medical underwriting. The exact rules and the length of the window are set by state law — confirm the current details before you rely on them.

How to find every insurer selling in Riverside

There is no single carrier list we can publish here, because Medigap availability changes and is set at the insurer/ZIP-code level. Three official sources will give you the current picture:

1. Medicare.gov Medigap policy search. Enter your Riverside ZIP code and plan letter to see the insurers licensed to sell that policy to you, along with contact information. 2. California Department of Insurance Medigap rate guide. Published periodically, it lists insurers and premium ranges for each standardized plan. 3. California SHIP (HICAP — Health Insurance Counseling & Advocacy Program). Free, unbiased one-on-one counseling by trained volunteers. They can walk you through the list and explain the pricing methods.

Once you have the list, contact each insurer directly (or a licensed agent representing multiple carriers) and ask, for the same plan letter: what is the current premium, what pricing method is used, what has the rate history looked like, and what discounts apply.