Comparing Gap Insurance Costs Across the US: A 50-State Pricing Analysis

Content pillar: State-Specific Gap Coverage: Regulatory Landscape and Pricing
Context: Medical aid (Medicare Advantage) vs gap cover (Medigap / Medicare Supplement) decision content
Goal: Ultimate guide—how state rules, rating systems, and local market dynamics drive Medigap (gap) premiums across all 50 states, and how to make the right coverage decision for your situation.

Table of Contents

Executive summary — what this guide covers (quick takeaways)

Medigap (commonly called “gap insurance” in this context) protects Original Medicare enrollees from large out-of-pocket costs. Premiums vary widely by state due to differing regulations, market competition, and rating rules.
The national average Medigap premium sits substantially higher than typical Medicare Advantage premiums — that trade-off is central to the Medigap vs Medicare Advantage decision. (kiplinger.com)
A small group of states use community rating or mandate continuous guaranteed-issue rights; those states routinely show different pricing patterns (and consumer protections) than others. Knowing your state's rating system can save hundreds per year. (kff.org)
Big-picture: shop by plan (Plan G and Plan N dominate today), compare insurers, verify rating method, and check state guaranteed-issue rules before you buy.

What is gap insurance (Medigap) vs Medicare Advantage — short primer
National pricing snapshot: averages and extremes
How states shape Medigap prices — rating systems & guaranteed-issue rules
Regional patterns and 50-state implications (what to expect by region)
Side-by-side: Medigap vs Medicare Advantage — cost and access trade-offs
Practical shopping guide — timing, underwriting, and negotiation tactics
Real-world examples (case studies) comparing costs across states
Regulatory minefields: state-level quirks you must know
Conclusion: decision flowchart and next steps
References and internal links for deeper reading

1) What is “gap insurance” in the Medicare world?

When I use “gap insurance” here I mean Medicare Supplement Insurance (Medigap) — private policies sold to Medicare beneficiaries to fill the “gaps” left by Original Medicare (Parts A and B): deductibles, coinsurance, and some excess charges. Medigap plans are standardized (A–N), but premiums are set by private insurers and regulated at the state level. That behind-the-scenes pricing is the central driver of the coast-to-coast variation this guide analyzes. (medicare.org)

Key distinctions (quick):

Medigap supplements Original Medicare—nationwide provider access; typically higher premiums, lower unpredictable out-of-pocket risk.
Medicare Advantage replaces Original Medicare with a health-plan network—often lower premiums but more network restrictions and prior authorizations. (medicalnewstoday.com)

2) National pricing snapshot: averages, extremes, and the most important headline numbers

National average Medigap premium (all plans combined): widely reported at roughly $200–$220/month for recent years (varies by data source and plan mix). This average is materially higher than the average Medicare Advantage premium, which is in the low double-digits per month. (kiplinger.com)
Which plans dominate? Today Plan G is the most purchased Medigap option among new buyers (Plan F closed to new enrollees after 2020). Because Plan G is so popular, many state-by-state premium comparisons use Plan G as the benchmark. (medicareadvantage.com)
State extremes (representative examples):
- Some of the highest Medigap averages: New York and certain Northeast/urban markets show substantially higher Medigap averages.
- Some of the lowest: Hawaii, Iowa, and certain Midwest states often have much lower average premiums. These gaps can exceed $100–$150/month depending on plan and age. (cgaa.org)

Below is a compact statewide comparison of extremes (top 5 highest vs top 5 lowest average Medigap premiums from public analyses). Use it as a directional map — not a quote-for-quote shopping price.

Most expensive states (representative)	Most affordable states (representative)
New York (very high averages)	Wisconsin (low averages)
Connecticut / New Jersey (high)	Hawaii (low)
Massachusetts (high)	Iowa (low)
California (metro pockets high)	Minnesota (lower for many plan types)
Maryland / Pennsylvania (high pockets)	Idaho / some Midwest states (lower)

(Source: compiled state analyses; medigap averages and rankings are fluid year-to-year. See references.) (cgaa.org)

3) How states shape Medigap prices — three levers that matter

Three core state-level levers explain most cross-state premium variation:

Premium rating rules (community, issue-age, attained-age)
- Community rating: everyone of Medicare eligibility age pays the same premium regardless of age. This compresses age-based differences but can raise costs for younger beneficiaries (and lower them for older buyers). Eight states require community rating (e.g., CT, MA, ME, MN, NY, VT, WA, AR). (kff.org)
- Issue-age rating: premium is based on your age when you buy the policy (you lock in a lower rate if you buy younger).
- Attained-age rating: premium rises as you age, reflecting increasing risk.
Guaranteed-issue / open-enrollment rules
- A few states mandate broader guaranteed-issue rights (continuous or annual guaranteed issue) beyond federal minimums (notably: Connecticut, Massachusetts, Maine, New York). Those protective rules limit underwriting removal and affect pricing and competition. (kff.org)
Market competition & provider networks
- The number of insurers actively selling Medigap in a state and concentration of older adults influences rates. More competition generally yields lower premiums, all else equal. Rural vs urban markets also significantly affect price. KFF analyses show large variation in Medigap take-up and insurer presence across states. (kff.org)

Why this matters: two people with identical health and age can see dramatically different quotes in different states because rating method + guaranteed-issue framework + market competition combine to determine insurer pricing strategy.

4) Regional patterns and what you can expect in each part of the country

Northeast (NY, NJ, CT, MA): High per-capita medical costs, strong consumer protections (in some states), and dense networks result in higher Medigap premiums in many metro areas — but guaranteed-issue and community rating in some states create unique trade-offs (higher premiums for younger buyers, but stronger enrollment protections for people with health issues). (kff.org)
Southeast (FL, GA, AL, MS): Mixed. Florida has broad plan availability with aggressive price competition in some counties; retiree influx drives demand but also competition among carriers. Premiums can be moderate to high depending on county. Consider the Florida-specific analysis for deeper insight. (See internal links below.)
Midwest (WI, IA, KS): Some of the most affordable Medigap markets are here. Wisconsin, Iowa and Kansas often show lower averages — a combination of insurer competition and state pricing norms. (cgaa.org)
West (CA, WA, OR): Large state variance—California metro areas can be expensive due to high provider charges, but community-sized market pockets still allow competitive pricing in some areas. Washington has community-rating elements and statewide quirks. (medicareadvantage.com)
Mountain & Rural states: Smaller pools and fewer insurers may result in either surprisingly low rates (local competition) or high rates (limited supply). Always compare urban and rural county quotes.

5) Medigap vs Medicare Advantage — the trade-offs in plain language

When deciding "medical aid (Medicare Advantage) vs gap cover (Medigap)", weigh these dimensions:

Premium cost
- Medicare Advantage average premium: low (often <$20/month nationally for 2024–2026 averages), though plan designs vary. (helpadvisor.com)
- Medigap average premium: often between $150–$300/month depending on state, plan, age, and gender. Medigap reduces unpredictable high-cost risk at the expense of higher steady premiums. (kiplinger.com)
Out-of-pocket risk
- MA often has annual out-of-pocket maximums for in-network care (e.g., CMS caps in the low thousands), while Medigap typically reduces coinsurance/deductibles dramatically and can be lower-risk for catastrophic care.
Provider access
- Medigap + Original Medicare: virtually any provider that accepts Medicare.
- Medicare Advantage: limited to plan networks (HMO/PPO differences), potentially more restrictions and prior authorization.
Portability / switching
- If you start with Medicare Advantage and later return to Original Medicare, getting Medigap may be difficult or more expensive (due to medical underwriting) in most states. Some states provide broader guaranteed-issue protection; check your state rules before switching. (kff.org)

Bottom line: Medicare Advantage often wins on monthly premium; Medigap often wins on network freedom and predictable out-of-pocket costs. Use expected health care utilization, desire for provider choice, and state enrollment protections to decide.

6) Practical shopping guide — how to secure the best Medigap price where you live

Understand your state’s rating method (community, issue-age, attained-age). If your state is issue-age, buy earlier to lock better rates; if community-rated, age won’t affect price but other buyers’ costs matter. (kff.org)
Don’t skip the 6-month Medigap open enrollment window that begins when you enroll in Part B at age 65 — guaranteed issue and best underwriting terms typically apply in that period. Missing it can trigger medical underwriting and higher premiums later. (kiplinger.com)
Shop county-by-county: premiums vary at the county level; zip-code specific quotes can differ by insurer.
Compare the same plan letter across carriers (e.g., Plan G vs Plan N) — benefits are standardized; price and insurer financial strength are not.
Ask about discounts: spouse discounts, electronic payment discounts, non-smoker discounts, and household discounts can move the needle.
For people with tight cash flow but high future risk, consider a plan with lower premium but higher cost-sharing (Plan N) — or a Medicare Advantage plan if you are comfortable with networks.
Use state SHIP (State Health Insurance Assistance Program) counselors for unbiased local advice.

7) Case studies: three real-world buyer scenarios showing how state affects cost

Note: the numbers below are illustrative, using typical market differentials and average-plan pricing patterns. Use them to understand the direction and magnitude of state effects rather than as literal quotes.

Case A — “Alice, 66, healthy, wants freedom”

Lives in Des Moines, IA (lower-average Medigap market). Quotes: Plan G ≈ $120–$150/month. Lower premium + full provider access makes Plan G attractive. Over 5 years, Alice’s extra cost vs MA may be roughly $5k–$7k but with much smaller out-of-pocket risk.

Case B — “Ben, 72, recent retiree, lives in NYC, on a fixed budget”

Lives in New York City, NY (high Medigap market). Quotes: Plan G ≈ $220–$300/month (varies by borough and insurer). Ben might find Medicare Advantage plans with $0–$20 monthly premium more budget-friendly, but with network limits. Because NY has continuous guaranteed-issue protections, Ben can more easily switch back to Medigap if health conditions arise — however premiums will remain high. (cgaa.org)

Case C — “Carmen, 68, chronic conditions, Florida retiree”

Lives in Tampa, FL. Typical Plan G quotes in Florida can be mid-range; Medicare Advantage offers strong $0–$20 premium plans but with network management and prior authorization. For Carmen, Medigap could be a safer bet for predictable coverage of chronic-condition costs, but verify county-level pricing and carriers. (See Florida-focused article for county-level patterns.)

These examples demonstrate that identical medical profiles produce divergent cost trade-offs depending on state and local market.

8) Regulatory minefields and state-specific quirks you must check now

Guaranteed issue states: Connecticut, Massachusetts, Maine, New York (and others have partial protections). These states allow easier Medigap entry for people who missed initial enrollment or who switched from Medicare Advantage. Check KFF’s state-by-state breakdown before making permanent moves. (kff.org)
Community-rated states: eight states require community rating — Arkansas, Connecticut, Maine, Massachusetts, Minnesota, New York, Vermont, and Washington (confirm current year rules before buying). Community rating can raise prices for younger buyers but protect older buyers from steep attained-age increases. (kff.org)
Birthday rule: a limited number of states permit an annual plan change at birthday time without medical underwriting. If your state has a birthday rule, that may be a powerful tool to shop for better rates. (Check your state regulator’s consumer page.)
Medigap waivers: Massachusetts, Minnesota, and Wisconsin have a different Medigap standardization via federal waivers — compare plan features carefully in these states because the standardized letters are different.

Important: state rules change occasionally. Always verify with your state insurance department or SHIP counselor for the current year.

9) How to run your own 50-state comparison efficiently

If you want to build a realistic 50-state pricing comparison for your own decision or analysis:

Pick the plan(s) to compare (Plan G is the best baseline today).
Fix the age(s) and gender(s) of the sample enrollees (e.g., female/65, male/70).
Use at least three quotes per state from carriers available in each state — insurers vary by county.
Normalize to an annual cost and compute a 5-year and 10-year total cost estimate under each rating system assumption.
Factor in risk tolerance: low utilization favors MA for many; high utilization or frequent specialist visits favors Medigap.
Document state regulatory features (community-rated? guaranteed issue?) and note the effect on underwriting and price movement.

Large consumers or researchers should rely on reputable datasets (state insurance filings, KFF/NAIC, or proprietary aggregator reports) for precise state averages.

10) Conclusion — decision flow & next steps

If you value provider freedom and predictability: lean Medigap (Plan G or N) — but shop county-by-county and confirm your state’s rating method and guaranteed-issue protections. (kff.org)
If you prefer lower monthly premiums and are comfortable with networks/prior auth: Medicare Advantage may be an economical choice — compare plan designs and in-network hospitals. (helpadvisor.com)
Always compare identical plan letters across carriers, check household and payment discounts, and confirm your state’s special rules before enrollment.

Action checklist:

Get 3 carrier quotes in your county for Plan G and Plan N.
Check whether your state is community-rated, issue-age, or attained-age. (kff.org)
Confirm guaranteed-issue windows for your state (if you plan to switch later). (kff.org)
Schedule a free call with your State Health Insurance Assistance Program (SHIP) counselor for local guidance.

Detailed resources & internal deep dives (recommended next reads on insurancecurator.com)

References (selected authoritative sources used in this analysis)

KFF — Medigap Enrollment and Consumer Protections Vary Across States (state rating rules; guaranteed-issue summaries). (kff.org)
Kiplinger — “The ‘100% Overwhelming’ Decision: What Do You Do About Medigap?” (national Medigap averages; Plan G trends; enrollment timing). (kiplinger.com)
MedicareAdvantage.com — Average cost of Medicare & Plan G state benchmarks (Plan G averages by state and national MA/Medigap comparisons). (medicareadvantage.com)
CGAA / state Medigap guides — state-by-state Plan F/G historical averages and affordability comparisons used as directional pricing references. (cgaa.org)
HelpAdvisor — 2024 Medicare Advantage premiums by state (useful for MA vs Medigap premium comparisons). (helpadvisor.com)

If you want, I can:

Build a downloadable 50-state spreadsheet of Plan G sample quotes at age 65 and age 75 (county-level where available).
Run a personalized comparison for your ZIP code (Plan G vs Plan N vs Medicare Advantage) and map projected 5-year costs.
Summarize specific rules and guaranteed-issue windows for any state(s) you name.

Which would you like me to do next?