Medical underwriting is the process insurance companies use to determine whether they want to insure a new client. During Medicare supplement underwriting, you’re required to undergo a physical examination and provide information about your medical history and current health conditions.
The information an insurance company discovers during medical underwriting determines how much risk is involved in providing you with health care coverage.
Medicare supplement insurance, also known as Medigap coverage, is for the purpose of covering your out-of-pocket costs not covered by your Original Medicare or Medicare Advantage plan.
Many people purchase Medicare supplement plans because they’re interested in limiting the potential cost of treating a major health condition or they’d like to protect themselves in the event of an emergency.
If you’re new to Medicare or currently looking for affordable Medicare plans, you need to know your guaranteed issue rights so you can’t be denied coverage due to your past or current health problems. A licensed insurance agent can help you understand Medicare and review Medicare plans with you to determine whether you’re better off with Medicare Part B or an Advantage plan and if a Medicare supplement plan is right for you.
Are Medicare Advantage Plans Subject to Underwriting?
Advantage plans are bound by federal law to provide at least the same amount of coverage that Medicare Part A and Medicare Part B provides. They might also offer prescription drug coverage that’s normally provided under Medicare Part D. As long as you qualify for Original Medicare, you can’t be denied coverage for a Medicare Advantage plan.
Beginning in 2021, insurance companies offering Advantage plans aren’t able to require medical underwriting during open enrollment. This means you can obtain coverage without answering health-related questions, undergoing a physical examination or meeting any other medical underwriting requirements. Advantage plans must also cover you even if you have a preexisting condition.
What Is Guaranteed Issue and How Does It Affect Insurance Companies?
Everyone who’s eligible for Medicare has guaranteed issue rights that guarantee coverage. As long as they enroll during their open enrollment period and review Medicare supplement insurance plans during the six months after their enrollment in a Medicare plan, they can sign up and avoid underwriting. This is considered the Medigap open enrollment period.
If you don’t enroll in a Medicare supplement insurance plan during the Medigap open enrollment period, an insurance company has the right to underwrite your policy. This could impact your premiums or result in denial of coverage. In some cases, the insurance company may refuse to cover a preexisting condition for a waiting period of six months.
When Can an Insurance Company Require Underwriting for Someone Enrolled in the Federal Medicare Program?
In most states, your guaranteed issue rights expire six months after your open enrollment period for traditional Medicare ends. Some state laws offer exceptions, so if you’re looking to change your Medigap plan, speak with a licensed insurance agent to see which companies sell Medigap policies that fill your needs. Reviewing your coverage with a licensed insurance agent ensures the Medigap plan you select offers coverage for the correct medication and services you need.
There are many instances in which state law won’t allow you to avoid medical underwriting. You can still shop for a Medigap policy, but know that you’re going to have to share information about your preexisting conditions and have your medical provider turn over your medical records. If you already have health insurance through Medicare and a Medigap insurance policy, there are some times when it’s best to keep your coverage, such as if you’re treating a current health problem that a health insurance company won’t cover.
What Health Questions Are Required During the Medicare Supplement Underwriting Process?
When seeking a plan, you’re required to provide information about your current health problems and past medical history. The insurer is most interested in what conditions you’re being treated for now and whether you’re likely to undergo medical procedures in the near future. If you’re planning to have surgery, for example, an insurer may deny coverage because they don’t want to immediately pay for an expensive operation.
You may be required to answer questions about your specific exercise and dietary routine, current medications, whether your conditions require supplemental oxygen use, if you have a heart condition or if you suffer from diabetes. Your age, weight and lifestyle can also influence your chance of being approved for coverage. For example, Medigap plans may require a waiting period before you can receive full benefits if you’re a smoker.
How to Increase Your Odds of Approval
If you’re worried about whether you’ll be approved for a Medicare supplemental insurance plan, there are a few things you can do to increase your chance of finding a policy:
- Enroll in the plan early, when you’re still guaranteed acceptance.
- Seek professional medical advice from a licensed health insurance agency to find plans that provide the greatest approval odds.
- Wait until after an upcoming surgical procedure to apply, as your odds of approval increase after you’ve undergone the procedure and fully recovered.
- Be prepared to provide your medical records and proof that past medical problems have been resolved.
- Quit using products that contain nicotine such as tobacco or vape products.
- Avoid using illicit drugs, as insurers perform blood and urine tests during the underwriting process.
- Consider that some insurers deny coverage to patients using marijuana, even if it’s legal or used for medicinal purposes.
- Ask how the appeal process works in case you’re denied coverage so you can submit an appeal if you wish.
The Medicare-covered services offered by the federal government are often sufficient for most people without major health complications. Make sure you discuss your concerns with your agent if you’re new to Medicare and decide whether you really need a Medicare supplement insurance plan. There are some cases where you’ll save more money without one.
If you’re new to Medicare, call (800) 309-6889 to speak with some who can offer the Medicare help you need.