Medicare Supplement

Before you enroll: three Medigap questions to ask

DES MOINES, Iowa — If you have narrowed your Medicare Supplement (Medigap) search down to a single plan letter — say, Plan G or Plan N — the next question is the one that trips up a lot of shoppers: why does the same plan letter look so different from one insurer to another? In Polk County, where Des Moines sits, the Medicare.gov Medigap search currently lists 29 insurers offering standardized letters. The coverage inside a given letter is identical by law. What changes is how the insurer prices it, how often those prices go up, whether a household discount applies, and whether you have to answer health questions to get in.

Medicare SupplementDes Moines, IA

Here is how to compare apples to apples.

The plan letter is the same everywhere — the price rules are not

Medigap plans sold in Iowa are standardized: Plan G is Plan G, Plan N is Plan N, and so on, no matter whose name is on the envelope. What insurers can compete on is price, service and how they set future increases.

For people newly eligible for Medicare today, the letters available are A, B, D, G, G-HD, K, L, M and N. Plans C and F are only available to people who were eligible for Medicare before January 1, 2020. The full table below shows every insurer selling in Iowa and which letters each one offers.

The three pricing methods to ask about

When you call an insurer or read a rate guide, ask which of these three methods they use for the letter you want. It is the single most important thing to understand about your future premium.

• Attained-age rated. The premium is based on your current age and goes up as you get older. It often starts lower and rises over time.
• Issue-age rated. The premium is based on your age when you first bought the policy. It does not rise just because you had a birthday, though it can still go up for other reasons.
• Community rated (no-age-rated). Everyone who has the policy pays the same base premium regardless of age.

All three methods can still see increases tied to inflation and claims experience. None of them are "better" in the abstract — the right one depends on how long you plan to hold the policy and your budget now versus later.

Rate history: the number the ads do not show

A carrier's starting premium tells you what you pay this year. Its rate history tells you what tends to happen next. The Iowa Insurance Division publishes a Medicare supplement rate guide that shows recent increases by company and plan letter. Reviewing three to five years of history for the same letter across several insurers gives you a much clearer picture than a single quote does.

You can request the current guide from the Iowa Insurance Division or your local SHIIP counselor (Iowa's State Health Insurance Assistance Program), free of charge.

Household discounts and other price levers

Many, but not all, Iowa Medigap insurers offer a household discount — a percentage off the premium if you live with another adult, or if a spouse also has a policy with the same carrier. The size of the discount and the rules for qualifying vary widely. Some require a spouse to be enrolled; others count any adult household member. Always ask, and always ask whether the discount stays in place if the other person moves out or passes away.

Payment method discounts (for example, for paying annually or by electronic funds transfer) are also common and worth asking about.

Underwriting: when insurers can ask about your health

This is where timing matters more than shopping.

During your Medigap Open Enrollment Period — the six months that begin the month you are 65 or older and enrolled in Medicare Part B — insurers in Iowa cannot deny you a Medigap policy or charge you more because of your health. You have guaranteed-issue rights.

Outside that window, in most cases, insurers can use medical underwriting. That means they may ask health questions, review prescriptions, and decline your application or offer a higher rate. A few limited guaranteed-issue situations still apply, such as losing certain coverage involuntarily. If you are past your open enrollment window and thinking about switching insurers for the same letter, call your Iowa SHIIP counselor first to confirm which rules apply to you.

How to actually compare, step by step

1. Decide on the plan letter that fits your budget and how much cost-sharing you want to handle. The letter, not the insurer, sets your benefits. 2. Pull the list of insurers offering that letter in your ZIP code from the Medicare.gov Medigap search. In Des Moines (50309), the search currently returns 29 insurers across all standardized letters. The table below shows which letters each insurer sells in Iowa. 3. For each insurer on your short list, ask: what pricing method do you use for this letter, what were your rate changes for the last three to five years, is there a household discount, and what underwriting will apply to me right now? 4. Cross-check the rate history against the Iowa Insurance Division's rate guide. 5. Confirm you are inside a guaranteed-issue window, or that you can pass underwriting, before you cancel any existing coverage.