Medicare Supplement

How Medigap Prices Are Set — And Why Yours Can Climb

How Medigap Prices Are Set — And Why Yours Can Climb — plain-language Medicare information for Winter Garden, Florida.

WINTER GARDEN, Fla. — If you've ever compared Medigap policies and wondered why two people with the same coverage can pay very different premiums, the answer usually comes down to one thing: how the insurance company prices the policy.

Medigap (also called Medicare Supplement Insurance) plans are standardized. That means a Plan G sold by one insurer covers the same things as a Plan G sold by another. What isn't standardized is the price — and, just as important, how that price changes over time.

Here in Winter Garden, which sits in Orange County, retirees weighing a Medigap policy should understand the three pricing methods insurers use before signing anything.

The three ways Medigap is priced

According to Medicare.gov, insurers can use one of three pricing methods for a Medigap policy:

Community-rated (also called "no-age-rated"). Everyone who has the policy pays the same base premium, no matter their age. A 65-year-old and an 80-year-old with the same plan pay the same starting rate. The premium can still go up over time, but not because you got older.

Issue-age-rated (also called "entry-age-rated"). Your premium is based on the age you were when you bought the policy. The younger you are when you buy in, the lower your starting premium — and it won't go up simply because you have another birthday.

Attained-age-rated. Your premium is based on your current age and rises as you get older. These policies often look cheap at 65 but climb as you age into your 70s and 80s.

Why premiums can rise even though benefits can't change

Here's the part that surprises a lot of people: once you buy a Medigap policy, the insurer can't cut your benefits. The coverage is locked in and standardized by Medicare's rules. But the premium is not locked in.

Rates can go up for reasons that have nothing to do with your individual health:

• Inflation. Medical costs generally rise each year.
• Claims experience. If the pool of people on that policy uses more care than expected, the insurer may raise rates for the whole group.
• Your age, but only if the policy is attained-age-rated.

Insurers usually need state approval to raise rates, and increases apply to everyone in the same rating class — not just to you.

Which method is offered where you live

Which pricing methods you'll see depends on the insurer and the state. Some states require community rating; others allow all three methods; and within any state, individual carriers may choose which to offer.

That's why it's worth asking, in writing, which method a policy uses before you enroll. It's a simple question, and the answer tells you a lot about what the next 10 or 20 years of premiums might look like.

What to ask before you buy

Before you sign up for a Medigap policy in the Winter Garden area, consider asking:

• Which pricing method does this policy use — community-rated, issue-age-rated, or attained-age-rated?
• How often has the company raised rates on this policy in recent years?
• Am I in my Medigap Open Enrollment Period, when insurers generally can't turn me down or charge more for health reasons?
• What happens to my premium if I move to a different state?

Your six-month Medigap Open Enrollment Period starts the month you're 65 or older and enrolled in Part B. It's the strongest window for buying a Medigap policy, because insurers generally can't use your health to deny coverage or bump up your price during that time.

Where Medigap fits in the bigger picture

Medigap works alongside Original Medicare. It doesn't include drug coverage — that's Part D, which has its own rules for 2026, including a $2,100 out-of-pocket cap on covered drugs and a maximum deductible of $615. The coverage gap (the old "donut hole") was eliminated as of 2025, and there are now three payment phases instead of four. There's also the Medicare Prescription Payment Plan, which lets you spread your drug costs across the year in monthly payments.

If your income is above $109,000 as a single filer in 2026, an IRMAA surcharge may apply to your Part B and Part D premiums.

For Medicare Advantage instead of Original Medicare, the Annual Enrollment Period runs Oct. 15 – Dec. 7, and the Medicare Advantage Open Enrollment Period runs Jan. 1 – March 31.