Attained-Age, Issue-Age, and Community-Rated Medigap Pricing Explained

Why the Same Plan Letter Can Behave So Differently

Medigap benefits are standardized. A Plan G from one insurer pays the same share of Medicare-approved costs as a Plan G from any other insurer, and it works the same way in every state except Massachusetts, Minnesota and Wisconsin, which use their own standardized formats. What is not standardized is the price, and, just as important, the formula behind the price.

When you look at two quotes for the same plan letter, you are not only comparing two numbers. You are often comparing two different philosophies about how age should factor into what you pay. One insurer might charge you based on how old you are today. Another might lock in a rate based on how old you were the day you bought. A third might charge everyone the same amount regardless of age. Those choices shape what your premium looks like at 66, at 76, and at 86.

Medicare.gov describes the three methods in plain terms, and so does the Kaiser Family Foundation (KFF) in its Medigap research. The rest of this post walks through each one, the trade-offs, and how to compare policies fairly.

Community-Rated: Age Doesn’t Enter the Formula

With community rating, which Medicare.gov sometimes labels “no-age-rated,” the premium is generally the same for everyone who holds that policy, whether they are 65 or 85. Age is not used to set the price, and neither, in most cases, is gender.

That does not mean the premium never moves. Premiums on a community-rated policy can still rise over time because medical costs rise, because of inflation, and because of changes in how the insured group uses care. Medicare.gov notes that other factors, such as where you live, medical underwriting and discounts, can still affect the premium. The distinction is that your birthday is not one of the factors.

The usual trade-off is the starting point. Because younger buyers are being charged on the same scale as older buyers, the initial premium for a newly eligible 65-year-old is often higher than what an attained-age policy would show. In exchange, the premium does not step up simply because you are older. People tend to value this predictability most later in retirement, when the budget is more likely to be fixed.

Community rating is also the method that some states require. KFF’s most recent published state breakdown, from 2024, lists nine states (Arkansas, Connecticut, Idaho, Maine, Massachusetts, Minnesota, New York, Vermont and Washington) that require community rating for people 65 and older. State rules can change, so confirm the current list with your state insurance department or an agent. If you live in one of those states, the question of which method to choose largely answers itself.

Issue-Age-Rated: Your Starting Age Gets Locked In

Issue-age rating, sometimes called “entry-age rating,” bases your premium on how old you were when you bought the policy. Someone who buys at 65 is priced as a 65-year-old, and the premium does not climb because they turn 66, 70, or 80. The younger you are at purchase, the lower your starting premium.

Again, “does not increase with age” is not the same as “never increases.” Issue-age policies still go up for the same reasons any insurance does, such as rising claims costs. The specific thing that is removed is the age-based step.

Issue-age pricing often lands in the middle. The starting premium is often higher than an attained-age policy for the same person, and it can be lower than what a community-rated policy would charge a person of the same age, though this varies by insurer. Over a long stretch of retirement it can make a difference, though how much depends on how fast premiums increase overall.

One detail worth understanding: the “issue age” belongs to that particular policy. If you later move to a different Medigap policy, the new policy is priced based on your age when you buy the new one. Issue-age pricing rewards staying put, but it also means that switching policies later in life can restart the clock at an older age, a point explained further in our guide to changing your Medigap policy.

Attained-Age-Rated: The Premium Follows Your Birthday

With attained-age rating, the premium is based on your current age. It goes up as you get older, in addition to any increase from inflation or rising medical costs. The advantage is a lower starting price, which is why attained-age policies often look most attractive on a quote sheet for someone who has just turned 65.

The step-ups can be structured different ways. Medicare.gov’s example shows the premium rising each year, and some insurers may instead use age bands, holding the rate steady for a few years and then moving it when you cross into the next band. Ask the insurer how often the age-based increase happens. Either way, the direction is the same: the premium you pay later is built on top of your older age.

This is where the “cheapest” policy at 65 can turn into one of the more expensive ones years down the road. It is not guaranteed to work out that way, because rate increases on all three types depend on claims experience, and a community-rated policy can climb quickly in a bad year. But structurally, attained-age is the method with the steepest built-in upward slope.

For some people it is still a reasonable choice. A buyer who expects to switch policies periodically, or who cares most about the lowest early premium, may weigh it differently than someone who wants to avoid age-based increases. The point is to make the choice knowingly.

Picturing How the Three Behave Over Time

Rather than invent numbers, it helps to imagine the shape of each premium on a graph, with age along the bottom and monthly cost up the side. Medicare.gov’s own illustrations show the same pattern: a premium that goes up each year under attained-age rating, and a premium that does not change with age under the other two. Medicare.gov notes that its example amounts are not actual costs.

Here is the comparison in one place.

Pricing method	How your age is used	Typical shape over time
Community-rated	Not used	Highest start, fairly flat
Issue-age-rated	Age when you bought	Middle start, fairly flat
Attained-age-rated	Your current age	Lowest start, rises with age

The lines can cross at some point. For how many years the attained-age line stays below the others, and when it passes them, depends on the insurer’s specific rates and how long you hold the policy. No general rule tells you the crossing year, which is why an honest comparison asks for more than a single quote.

Which States Allow Which Method

Pricing rules are set by the states. KFF’s state breakdown groups them roughly this way:

• Nine states, in KFF’s most recent tally (published in 2024), require community rating for policyholders 65 and older.
• Four states, Arizona, Florida, Georgia and Missouri, allow issue-age rating but prohibit attained-age rating.
• The remaining 37 states and the District of Columbia allow any of the three, and insurers choose.

Ohio, Kentucky and Indiana are not among the states KFF lists as requiring community rating or issue-age rating, so they fall in the last group, meaning insurers can use different methods and you can see more than one in the same market. Ohio’s Medicare supplement rule (Ohio Administrative Code 3901-8-08) also calls for the renewal provision on a policy’s first page to include any automatic renewal premium increases based on the policyholder’s age, and it says an insurer may not use or change premium rates unless they have been filed with and approved by the superintendent of insurance. Rules can change, so it is sensible to confirm with your state insurance department or an agent who works in your state. Our overview of Ohio Medigap regulations covers what is specific to Ohio.

Some states also have rules about how much a premium can differ for the same plan, or about enrollees under 65. Those are separate from the three rating methods, so the rating method on its own does not tell you everything.

Other Things That Move a Medigap Premium

Age is only one piece. Depending on the insurer and the state, your premium may also reflect:

• Your ZIP code or region.
• Tobacco use.
• Gender, in states that allow it.
• Household discounts when a spouse also buys with the same company.
• Payment method discounts, such as automatic bank draft.

These can change your quote noticeably, and they interact with the rating method. A discount does not change whether a policy is attained-age or issue-age. It just reduces the starting number.

Rate increases are a separate subject from rating method. Any Medigap policy can see premium changes over time, and we explain why in our post on Medicare Supplement rate increases. Rating method describes how your age is used. Rate increases describe how the insurer’s base rates move.

Comparing Policies Fairly

A quote tells you what you will pay this year. To see which policy fits your situation, ask a few more questions:

• Which method does this policy use, and where is that stated in writing?
• If it is attained-age, how often does the premium change for age, annually or by bands?
• What has the company’s rate history looked like for this plan in recent years, as far as it is willing to share?
• What discounts are included in the quote, and could they change?
• How long do I realistically expect to keep this policy?

Your time horizon matters most. If you are likely to hold the same policy for fifteen or twenty years, the pattern of how the premium grows will probably matter more than the opening number. If you may want to move, keep in mind what happens when you try to switch later: outside your Medigap open enrollment period or a guaranteed-issue situation, many states allow the insurer to ask health questions and decline you. We cover that in why Medigap works differently from Part D open enrollment and in our explanation of Medigap medical underwriting. Your six-month Medigap open enrollment period is the window when you cannot be turned down for health reasons, so it is also the best time to look at all three methods side by side.

What This Means for the Decision

There is no single best method. Attained-age rewards a low starting cost and tolerance for rising premiums. Issue-age rewards long-term stability at a middle starting cost. Community rating rewards stability regardless of age, usually at the highest opening price. Which of these suits you depends on your budget, your health, how long you expect to keep the policy, and what is offered in your state.

What does not hold up is choosing on the first-year price alone without knowing how the policy is rated. It is a bit like comparing two cars by the monthly payment without asking whether the payment is fixed or adjustable. The number is real, but it is only half the story.

A Step-by-Step Way to Shop With the Pricing Method in Mind

Medicare.gov’s Medigap guide lays out a buying process in four steps, and the pricing method fits into the middle of it. Here is how the steps look when you add the rating question.

• Decide which plan letter you want. Medigap benefits are standardized in most states, so this decision is about coverage, not price. Remember, as the guide notes, that you might not be able to switch policies later.
• Find the companies that sell that letter in your state. Not every plan is sold in every state, and not every company sells every plan the state allows. Medicare.gov has a tool for finding which companies sell Medigap in your state.
• Ask each company for an official quote, and ask how the policy is rated. Medicare.gov says prices can change at any time based on when you buy, your health conditions, and more, so a quote is a snapshot rather than a promise.
• Apply, and use your free look period. After you receive the policy you have 30 days to decide whether to keep it.

Before step one, figure out whether you are inside your six-month Medigap open enrollment period or have a guaranteed issue right, since that determines whether the company can ask about your health at all. Medicare.gov suggests calling your State Health Insurance Assistance Program (SHIP) if you have questions. SHIP counselors are free, and some SHIPs publish a Medigap rate comparison shopping guide for their state that lists companies and their costs. Your State Insurance Department can tell you whether complaints have been filed against a company.

Questions to ask every company. Medicare.gov’s worksheet gives a useful list of questions. These are the ones that bear most directly on pricing, with a note on why each matters:

• “Do you price this Medigap policy using community rating, issue-age rating, or attained-age rating?” This is the single most important question in this post.
• “I’m this many years old. What would my premium be?” The quote only means something when it is for your age.
• If the answer is attained-age: “How frequently does the premium increase due to my age?” The answer tells you whether you are looking at annual steps or age bands.
• “Has the premium for this policy increased in the last three years due to inflation or other reasons? If so, by how much?” This does not predict the future, but it shows you how the company has behaved.
• “Do you offer any discounts?” Ask whether a discount is permanent or only applies for a period.
• “Do you use medical underwriting, and is there a waiting period for pre-existing conditions?” If you are in open enrollment or have a guaranteed issue right, underwriting does not apply. Otherwise it may.

Write the answers down side by side. Two quotes that look similar can differ greatly once you see that one is attained-age with annual steps and the other is issue-age.

Three Buyers, Three Different Answers

Hypothetical scenarios make the trade-offs more concrete. None of these describes a real person, and none is a recommendation.

Picture someone turning 65 who has just enrolled in Part B. Their six-month window is open, and they expect to keep the same policy for decades. For them the shape of the premium over twenty years matters more than the first-year number, so they may value a method that removes age from the formula, even if it costs more at the start.

Now picture a buyer who is 72 and moving from another kind of coverage. The gap between methods may look different, because an attained-age quote and an issue-age quote are now both based on an older age. They would want to know which method leaves them with the more predictable path from here, and whether their health lets them qualify if they ever want to change.

Finally, picture a buyer who expects to move to another state. Medicare.gov says that in general you can keep your Medigap policy regardless of where you live as long as you still have Original Medicare, although the premium may change when you report your new address. For this buyer, how the new state treats the pricing method is one more reason to ask the company what would happen at renewal after a move.

In each case the pricing method is one input among several, and the right answer depends on budget, health and time horizon.

Mistakes That Can Cost Money Later

A few mistakes come up often when people compare Medigap prices.

• Comparing a first-year attained-age quote with a first-year community-rated quote as if they were the same kind of number. They are not, because one is built to rise and the other is not.
• Assuming “no increases for age” means “no increases.” Issue-age and community-rated premiums can still rise for inflation and other reasons.
• Forgetting that you can’t always switch later. Outside your open enrollment period or a guaranteed issue situation, many states let insurers ask health questions, and a company can decline you. Choosing a policy because “I can always change if it gets expensive” can be a risky assumption.
• Ignoring discounts that disappear. A household or payment discount can make a quote attractive, so ask whether it can change.
• Skipping the written confirmation of the rating method. Ask to see it in the policy documents, not only on the phone.

If You Already Have a Policy and the Premium Is Climbing

Many people read about pricing methods after they receive a bill that went up. Start by finding out why. Ask the insurer whether the increase is an age-based step, a general rate increase, or both. If your policy is attained-age, part of the change is built in. If it is issue-age or community-rated, the change reflects the company’s rates rather than your birthday.

If you are thinking about a different policy, Medicare.gov’s guide sets out several points. In most cases you do not have a federal right to switch Medigap policies unless you are within your six-month open enrollment period or have a guaranteed issue right, though some states have their own rules, so check with your State Insurance Department. If you decide to switch, do not cancel your first policy until you have decided to keep the second one. The application will ask you to promise to cancel the old policy, and you have 30 days from receiving the new one to decide whether to keep it. You pay both premiums for the month you have both. If you have had your current policy less than six months and want to change, a new policy may make you wait up to six months to cover a pre-existing condition, with credit for the time you have already had coverage. If you have held the old policy longer than six months and the new one has the same benefits, the new company can’t exclude a pre-existing condition or impose a waiting period.

Our posts on why Medigap rates rise and how underwriting decisions are made go deeper, and our page on changing your Medigap policy explains the options.

Frequently Asked Questions

What is the difference between attained-age and issue-age Medigap pricing?

Attained-age premiums are based on your current age and rise as you get older. Issue-age premiums are based on your age when you first bought the policy and do not rise because of age, though they can still go up for other reasons such as inflation or claims costs.

Is community-rated Medigap always the most expensive?

Not always, but it often starts higher than an attained-age policy for a newly eligible 65-year-old, because everyone pays the same price regardless of age. Over a long period the gap can narrow or reverse, depending on the insurer’s rate history and how long you keep the policy.

Can my Medigap premium still go up if it is issue-age or community-rated?

Yes. Those methods remove age as a factor, but premiums can still rise because of inflation, higher medical costs, or changes in how the insured group uses care.

Does the pricing method change if I switch to a different Medigap policy?

A new policy uses its own rating and its own issue age, which is your age when you buy it. That is one reason it helps to think about how long you plan to keep a policy before you buy.

How do I find out which method a policy uses?

Ask the insurer or agent, and look for the rating method in the policy’s outline of coverage or premium information. Medicare.gov calls the three methods community-rated (or no-age-rated), issue-age-rated (or entry-age-rated), and attained-age-rated.