Medicare Supplement

Before You Pick a Medigap Insurer in San Francisco

If you live in San Francisco and you're shopping for a Medigap policy, here's a fact that surprises a lot of people: a Plan G is a Plan G, no matter which insurer sells it. The federal government standardizes Medigap coverage, so the letter on the plan tells you exactly what it covers. What actually changes from one insurer to the next is the price you pay, the way that price is set, and the rules for signing up.

Start with the plan letter, not the insurer

San Francisco is in San Francisco County, and the Medigap plans available there are the same standardized letters sold across California. If you're newly eligible for Medicare today, you can choose from Plans A, B, D, G, G-HD (high-deductible G), K, L, M and N. Plans C and F are only available if you became eligible for Medicare before January 1, 2020.

Once you pick a letter, the benefits are locked in by federal rule. A Plan N from one company pays the same share of your Part B coinsurance as a Plan N from any other. That's why comparing insurers within the same letter is the fairest way to shop — you're truly comparing apples to apples.

How to find the insurers selling in your ZIP code

There isn't one single public list of every Medigap insurer in California that we can drop into this article, so here's how to build your own list for a San Francisco ZIP code:

• Medicare.gov Medigap policy search. Enter your ZIP code at medicare.gov and it will list every insurer licensed to sell each plan letter in your area, along with contact information.
• California Department of Insurance rate guide. The state publishes a Medicare Supplement rate comparison that shows sample premiums by age and pricing method. Search for "California Medicare Supplement rate guide" on insurance.ca.gov.
• HICAP (California's SHIP). The Health Insurance Counseling and Advocacy Program offers free, unbiased one-on-one help. You can reach them at 1-800-434-0222.

The three pricing methods — and why they matter

Two insurers can sell the exact same Plan G and set very different premiums, largely because of how they price the plan. In California, you'll see three methods:

• Attained-age rated. The premium starts lower when you're younger but goes up as you age. This is the most common method.
• Issue-age rated. The premium is based on your age when you first buy the policy, and it doesn't rise just because you get older. It can still increase due to inflation or claims trends.
• Community rated. Everyone with the plan pays the same base premium regardless of age. Younger buyers pay more than they would with attained-age; older buyers often pay less.

None of these is automatically "better" — the right fit depends on how long you expect to hold the plan and what you can afford now versus later.

Rate history, household discounts and underwriting

Beyond the pricing method, three other factors separate one insurer from another on the same plan letter:

Rate history. Ask each insurer, or check the state rate guide, for how much they've raised premiums on that plan letter over the past 3 to 5 years. A low starter price with steep annual hikes may cost more over time than a slightly higher starter price that stays steady.

Household discounts. Some insurers offer a small percentage discount if you live with another adult, or if a spouse or partner also enrolls. The size, rules and even the word used ("household," "spousal," "cohabitation") vary by company.

Underwriting. During your six-month Medigap Open Enrollment Period, which starts when you're 65 or older and enrolled in Part B, insurers must sell you any Medigap plan they offer, regardless of your health. Outside that window — and outside of California's "birthday rule," which lets you switch to an equal or lesser plan each year around your birthday — insurers can use medical underwriting. Each company has its own health questions and rules, so an applicant who's turned down by one may be accepted by another.

Putting it together

When you compare the same plan letter across insurers, look at:

1. The monthly premium at your current age. 2. The pricing method (attained-age, issue-age or community-rated). 3. The insurer's rate increase history in California. 4. Any household or spousal discount you qualify for. 5. Whether you're inside a guaranteed-issue window or will need to answer health questions.

The table on this page can help you see which plan letters exist. The insurer-level comparison — the piece that decides your actual premium — is best done through Medicare.gov, the California rate guide, or a HICAP counselor.