Medicare Supplement

How California Medigap insurers price the same plan letter

If you live in San Diego and are shopping for a Medicare Supplement policy — also called Medigap — the first thing worth knowing is this: a Plan G from one insurance company covers the same things as a Plan G from any other. The federal government standardizes the letters. What changes from one company to the next is the price, how that price will move over time, and the rules for getting in.

Medicare SupplementSan Diego, CA

That means your job as a shopper is less about hunting for a "better" Plan G and more about comparing how each insurer prices and manages the same coverage. Here is how to do that in California.

San Diego is in San Diego County — but Medigap works statewide

Unlike Medicare Advantage, Medigap is regulated at the state level. In California, the same set of standardized plan letters is available to San Diego residents as to anyone else in the state. Which companies actually sell each letter, and at what price, is where the local shopping happens — and rates can vary by ZIP code within San Diego County.

Because the plan letters are federally standardized, no insurer can add or remove benefits from a letter. A Plan N is a Plan N. If a sales pitch suggests one company's Plan G has "extra" hospital or doctor coverage, that is not how Medigap works.

The plan letters you can buy today

People newly eligible for Medicare today can choose from Plans A, B, D, G, G-HD (high-deductible G), K, L, M and N. Plans C and F are closed to anyone who became eligible for Medicare on or after January 1, 2020; if you were eligible before that date, you may still be able to buy them.

Not every insurer sells every letter, so part of comparing carriers is checking which letters each one actually offers in your ZIP code.

The three pricing methods — this is where insurers really differ

Two insurers can sell an identical Plan G and price it very differently over your lifetime because California allows three ways of setting Medigap premiums:

• Community-rated (no-age-rated): Everyone with the same policy pays the same base premium, regardless of age. Premiums can still go up over time due to inflation or claims trends, but not because you had a birthday.
• Issue-age-rated: Your premium is based on your age when you first bought the policy. It does not go up as you age, but it can still rise from inflation.
• Attained-age-rated: Your premium is based on your current age and generally rises as you get older, on top of any inflation increases.

An attained-age policy is often the cheapest at age 65 and the most expensive at 80. An issue-age or community-rated policy may look higher on day one and hold up better later. Neither is universally "better" — it depends on how long you plan to keep the policy and your budget over time. Ask each insurer, in writing, which method they use.

Rate history, household discounts and underwriting

Beyond the pricing method, three more things separate one insurer from another:

• Rate history. Standardized plans do not protect you from annual rate increases. Ask each carrier — or your SHIP counselor — for the last several years of rate changes on the specific plan letter you are considering. A company with a steadier history may be worth a closer look even if its starting premium is not the lowest.
• Household discounts. Many California insurers offer a discount if a spouse or another adult in the household also has a policy, or sometimes just lives with you. The size and rules vary by company.
• Medical underwriting. During your six-month Medigap Open Enrollment Period, which starts when you are 65 and enrolled in Part B, insurers must sell you any policy they offer at the same price as a healthy person, regardless of health history. Outside that window, most Medigap applications in California can be medically underwritten, meaning an insurer can charge more or decline coverage based on your health. California also has a "birthday rule" that lets existing Medigap policyholders switch to an equal or lesser plan with the same or a different insurer during a set window each year without new underwriting — a useful tool if a competitor's price becomes more attractive.

How to find the insurers selling Medigap in your ZIP code

Because insurer lineups change, the most reliable way to see who currently sells each plan letter in San Diego is to go straight to the sources:

• Medicare.gov Medigap policy search. Enter your ZIP code to see the companies offering each standardized plan letter in your area.
• California Department of Insurance Medigap rate guide. The state publishes a rate comparison document that lists licensed Medigap insurers and sample premiums by age and region.
• California SHIP (HICAP). The Health Insurance Counseling and Advocacy Program provides free, unbiased Medicare counseling, including help comparing Medigap carriers side by side.

The table below lists every plan letter still available to new enrollees. Use it as your checklist when calling insurers or working with a counselor: same letter, same coverage, different price, different rules.