Medicare Supplement

Same Medigap Benefits, Bigger Bill? Here's Why

RICHARDSON, Texas — If you own a Medigap policy, you've probably noticed something confusing: the benefits printed on your policy never change, but the premium you pay can. That's not a mistake, and it's not your insurer sneaking in extra coverage. It's the way Medigap pricing works — and the method your insurer uses to set your rate can shape how much your premium grows over the years.

Medigap plans (also called Medicare Supplement plans) are standardized by the federal government. A Plan G sold by one company covers the same gaps in Original Medicare as a Plan G sold by another. What is not standardized is how each company decides what to charge you for that policy.

The three pricing methods, in plain English

Community-rated (also called "no-age-rated"). Everyone who buys the same policy from the same insurer pays roughly the same premium, no matter how old they are. A 65-year-old and an 80-year-old with the same plan pay about the same rate. Premiums can still go up over time, but not because you're getting older.

Issue-age-rated. Your premium is based on the age you were when you first bought the policy. Buy in at 65, and your rate is tied to that starting age. It won't rise simply because you turn 70 or 75 — though it can still rise for other reasons.

Attained-age-rated. Your premium is based on your current age and typically climbs as you get older. It may look cheap at 65 and cost significantly more at 80, even though the coverage is identical.

Why premiums rise when benefits can't

Federal rules require Medigap benefits within each lettered plan to stay the same. So if your bill goes up, it's not because the policy started covering more. Insurers typically raise premiums for three reasons:

• Inflation in the overall cost of health care.
• Claims experience — how much the insurer paid out for people in your plan and rating pool.
• Age, but only if you're in an attained-age policy.

That's why two neighbors with the exact same Plan G can pay very different premiums, and why their premiums can change on different schedules.

Which method applies to you?

Here's the part many shoppers miss: which pricing methods are offered depends on the insurance company and the state you live in. Some states require or restrict certain methods; others leave it up to insurers. That means a Richardson resident and a relative in another state may not have the same options, even from the same national carrier.

Richardson is in Dallas County, and the Medigap policies available to you are regulated at the state level by the Texas Department of Insurance, along with federal Medigap rules from CMS. Before you buy, ask the insurance company — in writing — which pricing method the policy uses.

Questions to ask before you enroll

• Is this policy community-rated, issue-age-rated, or attained-age-rated?
• How often have premiums for this plan increased in the last several years?
• What is the premium today, and what would it be at 75 or 80 under this pricing method?
• Am I inside my Medigap Open Enrollment Period, when insurers generally can't turn me down or charge more based on health?

Those answers can matter more over 20 years of retirement than the sticker price on day one.

How Medigap fits with the rest of Medicare

Medigap only works alongside Original Medicare (Parts A and B). It does not include drug coverage, so most Medigap enrollees also sign up for a stand-alone Part D plan. A few 2026 Part D facts worth knowing:

• The out-of-pocket cap for covered drugs is $2,100 in 2026.
• The maximum Part D deductible is $615.
• The old coverage gap ("donut hole") was eliminated in 2025 — there are now three payment phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly amounts.
• IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026.

Enrollment windows to keep on your calendar: Medicare Annual Enrollment runs Oct. 15 – Dec. 7, and Medicare Advantage Open Enrollment runs Jan. 1 – March 31. Medigap has its own separate rules and doesn't follow those dates.