Medicare Supplement Underwriting

Answering questions about Medicare Supplements is not always necessary. The health question requirements may be waived during your Open Enrollment Period, for example. Changing your Medigap policy or missing your OEP will likely require underwriting.

Video Explanation

Medicare Supplement Underwriting Questions

To qualify for new coverage in many states, you must answer questions about your health and pass underwriting. Although medical underwriting can be stressful, many people pass underwriting and change coverage each year, so don’t worry.

Let’s look at the situations typically leading to approval. After that, let’s discuss when you might encounter difficulties changing plans. You can use this information to figure out if you’re eligible for Medigap coverage.

Guaranteed Issue: No Health Questions

In the six months after turning 65 and activating your Part B, you have an open enrollment period for Medigap. After doing Medigap research, you will realize that you can apply without underwriting. A guaranteed issue right allows a policy to be issued without underwriting.

State Specific Rules

During their birthday month, beneficiaries in five states can change Medigap policies without going through underwriting. The beneficiary must have a current supplement policy in good standing. You may be able to get a lower rate through your agent.

A good deal can be applied for quickly and easily if there are no medical questions.

Washingtonians can apply at any time of the year for the supplement. Washington has therefore a higher supplement rate.

Read more: California Birthday Rule

How to Understand Medicare Supplement Underwriting Questions

You are now an expert in Guaranteed Issue situations! Your next step is to understand how carriers conduct underwriting.

Medigap applications are required to contain at least one medical question.

You will be asked if you have ever had a particular condition. Others may ask about more recent experiences. Health history is often asked about the last few years.

If you need to answer NO to some or all medical questions on your application, do so.

When you answer YES to an inquiry, most carriers will decline your application. As a result, you are not eligible for coverage, and there is no need for you to apply.

We recommend speaking to an expert about the possibilities based on state laws and specific carrier exceptions.

How long does the medical underwriting process take?

Medical underwriting can take anywhere from a week to a month depending on the carrier and the time of year. In the Annual Enrollment Period (AEP), many people are changing plans.

As a result, carriers receive a high volume of applications, slowing down the underwriting process.

Other than AEP, most carriers can answer your application within a week or two of when you submitted it.

Agent Tip

Apply for coverage during AEP as soon as it begins to ensure that you’ll be approved in time.

Approval may be given despite minor health problems

You no longer need to worry about specific injuries once you have fully recovered and finished treatment. The companies also don’t care if you had the flu twice this year or if you have seasonal allergies.

In the absence of a further or more serious problem, high blood pressure and cholesterol are unlikely to be an issue.

Minor arthritis wouldn’t raise issues, but more severe arthritis, such as rheumatoid arthritis, might cause coverage to dwindle.

When it comes to supplement plans, the Body Mass Index is not as strict as it is when it comes to life insurance. If you’re not morbidly obese, a few extra pounds aren’t an issue.

Every company has underwriting guidelines, and your broker will let you know what those are; this way, you won’t waste your time applying if you don’t get approved.

Complete all upcoming treatments and pending surgeries first

There have been several denials, and upcoming procedures are high on the priority list. Many insurance companies will not cover you before an expensive test or surgery.

Carrier’s require that your previous insurer cover your treatment before you apply for new coverage.

Even if your surgery is not life-threatening, you must still wait before applying. Complete your surgery and all follow-up appointments. After that, you can apply for a new insurance carrier.

Declined for Medications

Medigap carriers have access to prescription history records. On your application, you need to authorize the new carrier to access your prescription records.

Attempt to recall any medications you have recently been prescribed. Be truthful.

Auto-Decline Drugs

There is a list of medications that are automatically denied by Medigap carriers. These medications are used to treat chronic or serious conditions.

In taking these medications, you’re indicating that you might have a condition that would be costly to cover. Long-term use of painkillers can be problematic.

Underwriting Medicare Supplements: Where to Get Help

It is extremely important that you do not cancel your current coverage before you are approved with your new carrier. You will be notified by your agent to end the coverage with your previous carrier. Agents cannot cancel previous coverage, and you should never assume they will cancel previous coverage.

Fill out our contact form to get in touch with an agent in your area. You can also give us a call at 800-208-4974. Any questions you have regarding your medical underwriting or your benefits, we will be happy to assist you.