Medigap rating method is the system by which a Medigap insurance carrier sets and adjusts premiums over time. Federal law permits three rating methods for Medigap policies:
- Community-Rated (also called No-Age-Rated): All enrollees pay the same premium regardless of age
- Attained-Age-Rated: Premium is based on the beneficiary's current age and increases each year as the beneficiary ages, plus inflation
- Issue-Age-Rated: Premium is locked at the beneficiary's age at issue and increases only with inflation, not personal aging
Rating method choice is the critical long-term premium trajectory decision that can cost or save tens of thousands of dollars over decades of Medigap coverage. A 65-year-old beneficiary who enrolls in Medigap and lives to 95 will be on Medigap for 30 years. Across that 30-year window, the difference between rating methods compounds significantly in cumulative premium expense.
The Medigap rating method framework rests on:
- Federal Medigap rating regulations defining the three permitted rating methods and the rules for premium adjustments
- Social Security Act Medigap rate provisions establishing the federal floor for rate-setting practices
- NAIC Model Regulation for Medigap defining the technical implementation of each rating method
- Federal Medigap consumer protection statutes establishing the rating method framework and consumer protections
- Georgia State Insurance Code adopting the federal rating method framework without state-level method mandates
For Georgia eldercare specifically, Georgia permits all three rating methods. The same plan letter (e.g., Plan G) may be offered by different carriers using different rating methods. The beneficiary's rating method choice combined with carrier selection determines the long-term cost trajectory of their Medigap coverage.
Why Rating Method Matters in Georgia
Rating method matters in Georgia because:
Long-term cost trajectory varies dramatically across methods. A 65-year-old beneficiary on Medigap for 30 years can spend significantly different cumulative totals depending on rating method, even when starting premiums are similar.
Initial premium varies by method. Attained-age has the lowest initial premium for new-65 beneficiaries. Community-rated has the highest. Issue-age is in the middle. The initial premium signal can mislead beneficiaries who do not think about long-term trajectory.
Georgia permits all three methods. Beneficiaries have all three options to choose from. The same plan letter (Plan G) is available from carriers using each method.
Carrier-by-carrier method variation. Mutual of Omaha is primarily attained-age. Manhattan Life is community-rated. Bankers Fidelity is issue-age. Beneficiaries need to know which method a carrier uses before comparing premiums.
Switching rating methods later faces underwriting. Once enrolled in a Medigap plan, switching to a different carrier (with a different rating method) outside Medigap OEP or trial right faces medical underwriting in Georgia. Rating method choice at OEP is largely irreversible.
Long-life-expectancy beneficiaries hurt most by attained-age. Beneficiaries with strong family longevity history or who are themselves currently healthy at 65 are most penalized by attained-age over the long run.
For Georgia eldercare specifically:
- Georgia has a large Medicare beneficiary population, many enrolled in Original Medicare with Medigap
- Multiple Medigap carriers operate in Georgia using varying rating methods
- Attained-age is the most common method among Georgia carriers
- Community-rated carriers include Manhattan Life, Continental, and others
- Issue-age carriers include Bankers Fidelity and some smaller carriers
- GeorgiaCares SHIP provides free rating method counseling
Federal Legal Framework
The Medigap rating method framework rests on the following federal statutory and regulatory authorities:
Federal Medigap rating regulations define the three permitted rating methods (community-rated, attained-age-rated, issue-age-rated) and the rules for premium adjustments. They define how each method calculates and adjusts premiums.
Social Security Act Medigap rate provisions establish the federal floor for rate-setting practices. These provisions require carriers to file rates with state insurance regulators and limit unreasonable rate increases.
NAIC Model Regulation for Medigap is the National Association of Insurance Commissioners model framework with rating method specifications. It defines the technical implementation of each rating method that federal law incorporates.
Federal Medigap consumer protection statutes established the federal Medigap consumer protection framework including rating method definitions. Before these laws, Medigap insurers had wide latitude in rate-setting; the three-method framework emerged from federal consumer protection legislation.
Georgia State Insurance Code is the state-level Medigap regulation administered by the Georgia Department of Insurance. Georgia adopts the federal rating method framework and requires carriers to file rates with the Georgia DOI. Georgia permits all three rating methods without state-level mandates.
The Three Rating Methods Explained
Community-Rated (No-Age-Rated)
Mechanism: ALL enrollees pay the SAME premium regardless of age. A 65-year-old and an 85-year-old enrolling in the same Medigap plan from the same community-rated carrier pay the same premium.
Initial premium: HIGHER than attained-age and issue-age for new-65 beneficiaries (because the carrier averages across all ages).
Premium increases: Only for:
- General inflation
- Claim experience adjustments (if the carrier's claims experience requires it)
- NOT for personal aging
Long-term trajectory: Slowest premium increases over time. For a 30-year Medigap holder, community-rated produces a cumulative cost that falls between attained-age and issue-age.
Best for:
- Long-life-expectancy beneficiaries (family history of longevity, currently very healthy at 65)
- Beneficiaries planning to hold Medigap for 25+ years
- Beneficiaries comfortable with higher initial premium for stable long-term trajectory
Georgia carriers using community-rated:
- Manhattan Life (primary community-rated carrier in Georgia)
- Continental Life (community-rated for some plans)
- Bankers Fidelity (community-rated option for some plans)
- A handful of smaller carriers
Attained-Age-Rated
Mechanism: Premium is based on the beneficiary's CURRENT age. As the beneficiary ages, the premium increases each year based on the age-rate table PLUS inflation. A 65-year-old has the lowest premium; an 85-year-old has the highest premium for the same plan letter.
Initial premium: LOWEST for new-65 beneficiaries (because 65 is the lowest-cost age on the table).
Premium increases:
- Annual age-based increases (the 65 to 66 increase, 66 to 67 increase, etc.)
- Plus general inflation
- Plus claim experience adjustments
Long-term trajectory: Steepest premium increases over time. Premium rises substantially over a 30-year horizon and becomes the highest-cost method cumulatively despite the lowest initial premium.
Best for:
- Beneficiaries with shorter expected Medigap tenure (early-onset health concerns, short family longevity)
- Beneficiaries prioritizing minimum initial premium
- Beneficiaries who plan to switch to MA later (though switching back to Medigap faces underwriting in Georgia)
Georgia carriers using attained-age:
- Mutual of Omaha (primary attained-age carrier in Georgia, very common)
- AARP/UnitedHealthcare (attained-age for most plans)
- Cigna (attained-age)
- Aetna (attained-age)
- Humana (attained-age)
- Bankers Life (attained-age for most plans)
- Most other Georgia carriers
Issue-Age-Rated
Mechanism: Premium is LOCKED at the beneficiary's age at issue (when policy starts). A 65-year-old who enrolls pays the 65-year-old's premium for the rest of their life, with annual inflation adjustments. Premium does NOT increase based on personal aging.
Initial premium: MID-RANGE for new-65 beneficiaries (between attained-age low and community-rated high).
Premium increases:
- General inflation only
- Plus claim experience adjustments
- NOT for personal aging
Long-term trajectory: Moderate premium increases over time. For most beneficiaries with average or long life expectancy, issue-age produces the lowest cumulative cost across the three methods.
Best for:
- New-65 beneficiaries with average or long life expectancy
- Beneficiaries who want predictable cost trajectory
Georgia carriers using issue-age:
- Bankers Fidelity (primary issue-age carrier)
- Continental Life (issue-age for some plans)
- Some smaller niche carriers
Long-Term Cost Trajectory Overview
For a 65-year-old enrolling in Plan G who holds the policy for 30 years, the three rating methods produce meaningfully different cost trajectories.
Attained-age starts with the lowest monthly premium but compounds most steeply. Annual increases combine age-based adjustments with general inflation, making this method the highest-cost option cumulatively for long-tenure beneficiaries.
Issue-age starts with a mid-range premium and increases only with inflation and claims experience. Over 30 years, this method typically produces the lowest cumulative cost because age-based increases never apply.
Community-rated starts with the highest premium but increases only for inflation and claims experience. The cumulative cost falls between attained-age and issue-age for most long-tenure scenarios.
Critical insight: For most healthy 65-year-olds with average or longer life expectancy, issue-age provides the best long-term value. Attained-age's initial low premium is a deceptive signal.
Strategic Implications by Beneficiary Profile
Profile 1: Healthy New-65 with Long Life Expectancy
Best choice: Community-rated or issue-age Rationale: Long Medigap tenure means slow-trajectory methods win cumulatively. Higher initial premium is offset by slower increases over decades.
Profile 2: Healthy New-65 with Average Life Expectancy
Best choice: Issue-age Rationale: Issue-age has the lowest cumulative cost and a predictable trajectory. Mid-range initial premium is the price for long-term stability.
Profile 3: New-65 with Health Concerns or Short Family Longevity
Best choice: Attained-age Rationale: Shorter expected Medigap tenure means lower initial premium wins. The beneficiary will not be on Medigap long enough for attained-age's steep trajectory to compound significantly.
Profile 4: Older First-Time Enrollee (Delayed Part B at 70)
Best choice: Carefully consider; attained-age may still be best Rationale: Issue-age locks in the OLDER issue-age (70 in this scenario), making the issue-age starting premium higher. Community-rated may be competitive because the premium is the same regardless of enrollment age. Issue-age usually still wins long-term but the math is closer.
Profile 5: Beneficiary Planning to Switch to MA Later
Best choice: Attained-age (with awareness of switching limitations) Rationale: If shorter Medigap tenure before switching to MA, lower initial premium dominates. Switching back from MA to Medigap faces underwriting in Georgia (no state birthday rule); federal trial right only covers 12 months.
Profile 6: Long-Life-Expectancy Beneficiary Already on Medigap
Best choice: If currently attained-age, consider switching to community-rated or issue-age during OEP or trial right Rationale: Outside OEP and trial right, switching faces underwriting and may not be possible if health has changed.
Carrier-by-Carrier Rating Method Choices in Georgia
Mutual of Omaha
- Primary method: Attained-age
- Strong: A+ AM Best, large carrier, broad plan offering
- Considerations: Long-term trajectory steeper than community-rated alternatives
AARP/UnitedHealthcare (AARP-branded UHC Medigap)
- Primary method: Attained-age
- Strong: Largest Medigap insurer nationally, broad plan offering
- Considerations: AARP/UHC sometimes offers issue-age as an option for certain plans/states
Cigna
- Primary method: Attained-age
- Strong: Competitive pricing, voluntary OEP waivers
- Considerations: Mid-tier rate increase history
Aetna
- Primary method: Attained-age
- Strong: Competitive Plan G pricing
- Considerations: Aetna acquired by CVS Health affects long-term carrier strategy
Humana
- Primary method: Attained-age
- Strong: Available statewide
- Considerations: Humana more focused on MA than Medigap
Bankers Life
- Primary method: Attained-age
- Considerations: Agent-distributed only; not direct-to-consumer
Manhattan Life
- Primary method: Community-rated
- Strong: Community-rated trajectory for long-term holders
- Considerations: Higher initial premium offset by slower increases
Bankers Fidelity
- Primary method: Issue-age (and attained-age for some plans)
- Strong: Issue-age option for long-term predictability
- Considerations: Mid-tier carrier financial strength
Continental Life
- Primary method: Mixed (issue-age and community-rated options)
- Considerations: Mid-tier carrier; verify the specific method on any quote
USAA (for military veterans and family)
- Primary method: Attained-age
- Strong: Available to military veterans and immediate family
Globe Life and other smaller carriers
- Methods vary: Some attained-age, some community-rated
- Considerations: Check carrier financial strength and rate increase history
Premium Increases: Beyond Rating Method
Rating method determines the FRAMEWORK for premium adjustments. Beyond the rating method, premiums increase due to:
General inflation: Annual cost-of-living adjustments tied to Medicare cost inflation. Applies to all three rating methods.
Claim experience adjustments: When a carrier's claims experience requires rate increases (claims paid out exceed projections). These adjustments can vary significantly by year and carrier.
Medicare program changes: Changes to Medicare reimbursement and program structure affect Medigap costs.
Insurance regulator approval: The Georgia DOI must approve rate increases. State-level review can moderate excessive increases.
Carrier-specific factors: Some carriers have stronger underwriting discipline and lower rate increases over time. Others raise rates more aggressively.
Best Practices for Rating Method Selection
Understand the three methods before shopping premium. Initial premium signal is deceptive without rating method context.
Project 10, 20, and 30-year cost trajectory. Ask each carrier for their typical age-based premium table and rate increase history.
Consider family longevity and personal health. Long-life-expectancy means community-rated or issue-age wins; shorter expectancy means attained-age wins.
Get rate increase history from each carrier. Past 5-10 year rate increase patterns reveal carrier discipline.
Match method to expected Medigap tenure. Long tenure favors slow-trajectory methods (community-rated, issue-age).
Do not pick lowest initial premium alone. Attained-age looks cheapest at 65 but is most expensive cumulatively for long-tenure beneficiaries.
Consider switching limitations. Outside Medigap OEP or trial right, switching to a different rating method faces underwriting in Georgia.
Get GeorgiaCares SHIP counseling. Free, unbiased rating method counseling is available through GeorgiaCares SHIP.
Compare across carriers using the same method. The same rating method can have different premiums across carriers. Shop within method category.
Understand inflation and claim experience effects. Rating method does not insulate from inflation. All methods experience inflation adjustments.
Verify rating method on application. Confirm in writing which method applies to your policy.
Plan for premium increases. Even community-rated and issue-age increase with inflation. Budget for annual increases regardless of method.
Consider rate guarantee periods. Some carriers offer 1-year rate guarantees. Useful for budgeting but does not change long-term trajectory.
Document expected long-term cost. Save projections to compare against actual increases over time.
Common Issues with Rating Method Selection
Picking lowest initial premium without method context. Attained-age looks cheapest but compounds steepest.
Confusing rating method with carrier financial strength. These are different concepts. Community-rated from a weak carrier is worse than attained-age from an A+ carrier.
Assuming community-rated is always best long-term. Not for short-tenure beneficiaries.
Assuming attained-age is always worst. It is best for short-tenure beneficiaries.
Not asking carriers which method they use. Some carriers offer multiple methods; not all materials clearly state which applies.
Confusing rating method with rate guarantee. Rate guarantee is a short-term promise; rating method is a structural framework.
Not considering switching limitations. It is difficult to switch rating method later in Georgia (no birthday rule).
Picking issue-age at older issue-age (70+). Locks in a higher issue-age; may not be best at older enrollment.
Not considering family longevity. Strong family longevity means slow-trajectory methods compound favorably.
Not understanding that all methods experience inflation. Rating method protects only from age-based increases, not from inflation.
Picking carrier based on initial premium alone. The same method can have widely different premiums across carriers.
Not getting rate increase history. Carriers' actual rate increase patterns matter as much as rating method.
Underestimating long-term cumulative cost. Cumulative cost over 20-30 years is the true measure.
Confusing rating method with plan letter. Plan letter determines benefits; rating method determines premium trajectory. Both matter.
Frequently Asked Questions
Community-rated (same premium all ages), attained-age-rated (based on current age, increases with age), and issue-age-rated (locked at age at issue, increases with inflation only).
Yes. Georgia permits all three rating methods without state-level mandates. Beneficiaries can choose any method depending on which carriers offer it.
Attained-age-rated typically has the lowest initial premium for new-65 beneficiaries.
For most beneficiaries with average or long life expectancy, issue-age-rated produces the lowest long-term cumulative cost because it locks in the enrollment-age premium and increases only with inflation.
Switching to a different carrier (with a different rating method) outside Medigap open enrollment period or a trial right requires passing medical underwriting in Georgia. Georgia has no state birthday rule, so switching is difficult outside those protected windows.
Worked Examples
Example 1: Fulton 65 Margaret, Chose Attained-Age for Lower Initial Premium
Margaret turns 65 on April 15, 2026. Part B effective April 1. Medigap OEP April 1 through September 30. Margaret has Type 2 diabetes (controlled) and hypertension. She compares:
- Mutual of Omaha Plan G attained-age (lower initial premium)
- Manhattan Life Plan G community-rated (higher initial, slower trajectory)
- Bankers Fidelity Plan G issue-age (mid-range initial)
Margaret expects to be on Medigap until her late 80s (family history of moderate longevity). She prioritizes minimizing current cash outflow and selects Mutual of Omaha Plan G attained-age. Effective April 1, 2026.
Margaret's consideration: With roughly 20 years of expected Medigap tenure, attained-age's steeper trajectory is more manageable than it would be over 30+ years.
Example 2: DeKalb 67 James, Chose Issue-Age for Predictable Trajectory
James retired at 67 with continuous prior employer coverage. Part B effective March 1 via SEP. Medigap OEP March 1 through August 31. James researches rating methods and decides he prefers predictable long-term cost trajectory. He compares:
- AARP/UHC Plan N attained-age
- Manhattan Life Plan G community-rated
- Bankers Fidelity Plan G issue-age (issue-age 67)
James selects Bankers Fidelity Plan G issue-age. The issue-age locks in his 67-year-old premium for life, increasing only with inflation. Effective March 1, 2026.
James's insight: Issue-age avoids age-based annual increases, making the long-term cumulative cost lower than attained-age would produce over his expected Medigap tenure.
Example 3: Cobb 65 Robert, Chose Community-Rated for Long-Life-Expectancy
Robert turns 65 on May 15, 2026. Part B effective May 1. Medigap OEP May 1 through October 31. Robert's parents are 92 and 90, both still healthy. Robert is currently very healthy with no chronic conditions. He expects to be on Medigap for 30+ years.
Robert compares:
- Mutual of Omaha Plan G attained-age (lowest initial)
- Manhattan Life Plan G community-rated (highest initial, slowest trajectory)
- Bankers Fidelity Plan G issue-age (mid-range initial)
Robert selects Manhattan Life Plan G community-rated. Higher initial premium but slowest trajectory over 30+ years. Effective May 1, 2026.
Robert's insight: For a 30-year horizon with strong longevity, community-rated's slower trajectory outweighs its higher initial premium.
Example 4: Worth County 66 Linda, Community-Rated Manhattan Life Plan G
Linda's husband died in 2025. Her late husband's retiree coverage ended. Part B effective May 1 via SEP. Medigap OEP May 1 through October 31. Linda is 66 and in good health. She compares five carriers offering Plan G and notes that Manhattan Life's community-rated Plan G is competitively priced while offering community-rated's slow trajectory. She selects Manhattan Life Plan G community-rated. Effective May 1, 2026.
Example 5: Bibb 70 David, Issue-Age Locks in Late-Enrollment Age
David delayed Part B due to employer coverage. Retires at 70, Part B effective March 1, 2026 via SEP. Medigap OEP March 1 through August 31, 2026. David is 70 at issue. He compares:
- Mutual of Omaha Plan G attained-age (at age 70)
- Manhattan Life Plan G community-rated (same for all ages)
- Bankers Fidelity Plan G issue-age (at age 70, locks in the 70-year-old rate)
David's 70-year-old issue-age premium is higher than the community-rated premium. For David, community-rated is better than issue-age at this age. Community-rated trajectory will be slower than attained-age, and the starting premium is competitive.
David selects Manhattan Life Plan G community-rated. Effective March 1, 2026.
Example 6: Hall 65 Sarah, Long-Term Projection Comparison
Sarah turns 65 on March 15, 2026. Part B effective March 1. Medigap OEP March 1 through August 31. Sarah works with a GeorgiaCares SHIP counselor to project long-term cost across rating methods using actual carrier rate history.
Attained-age starts lowest but compounds most steeply over 30 years. Issue-age starts in the middle and produces the lowest cumulative cost. Community-rated starts highest but produces a cumulative cost that falls between the other two methods.
Sarah's family longevity is strong (mother 88, father lived to 92). She expects 30 years of Medigap and selects Bankers Fidelity Plan G issue-age. Effective March 1, 2026.
Get Help with Medigap Rating Method Selection in Georgia
Medicare Information
- Medicare: 1-800-MEDICARE (1-800-633-4227), 24/7
- SSA Medicare Enrollment: 1-800-772-1213
Georgia SHIP: Free Medigap Rating Method Counseling
- GeorgiaCares SHIP: free, unbiased rating method counseling
- Georgia Senior Medicare Patrol: report Medigap fraud
Georgia Insurance Regulation
- Georgia Department of Insurance: Medigap rate increase complaints and carrier licensing
Beneficiary Advocacy
- Medicare Rights Center: 1-800-333-4114
- Patient Advocate Foundation: 1-800-532-5274
- Eldercare Locator: 1-800-677-1116
- 211 Georgia: community resources
Major Georgia Medigap Carriers
- Mutual of Omaha Medigap (attained-age)
- AARP Medigap via UnitedHealthcare (attained-age)
- Cigna Medigap (attained-age)
- Aetna Medigap (attained-age)
- Humana Medigap (attained-age)
Georgia Legal Aid
- Atlanta Legal Aid: 404-377-0701
- Georgia Legal Services: 1-800-498-9469
Georgia Medicaid (if dually eligible)
- Georgia DCH Member Services: 1-866-211-0950
Why This Article Matters
The federal Medigap rating method framework permits three rating methods: community-rated, attained-age-rated, and issue-age-rated. Each method has different implications for initial premium, long-term trajectory, and cumulative cost over decades of Medigap coverage.
Rating method selection is the critical long-term premium trajectory decision that can cost or save tens of thousands of dollars over decades. For a 65-year-old enrolling in Medigap who lives to 95, the difference between rating methods compounds significantly over 30 years. Attained-age has the lowest initial premium but worst long-term trajectory. Community-rated has the highest initial premium but slowest trajectory. Issue-age combines mid-range initial premium with no age-based increases, often providing the best long-term value for beneficiaries with average or long life expectancy.
For Georgia eldercare specifically, where Georgia permits all three rating methods and multiple carriers offer varying method choices, understanding rating method mechanics combined with carrier-by-carrier method awareness empowers Georgia beneficiaries to make the long-term cost-optimal Medigap decision. Combined with plan letter selection, enrollment timing (Medigap OEP and trial rights), and pre-existing condition rules, rating method completes the federal Medigap consumer decision framework.
Find personalized help choosing a Medigap rating method in Georgia at brevy.com.