What Health Questions Do I Have to Pass for Medigap Insurance?
Underwriting can be pretty intimidating. Even the word is confusing for a lot of people! In short, medical underwriting is a process used by insurance companies to verify your health status.
For the most part, insurance companies use medical underwriting to determine whether they should offer you coverage, and if so, at what price.
To qualify for a Medicare Supplement, also called Medigap plan, you typically have to go through medical underwriting. However, there are times when you don't, which you want to take advantage of!
There are always many questions when it comes to underwriting, including what kinds of questions insurance companies ask on a Medigap application, why you'd ever choose to go through underwriting, and so on. Let's tackle all of it!
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What Is Medical Underwriting?
Almost all kinds of insurance have underwriting processes. For example, if you've ever applied for a mortgage, you went through mortgage underwriting. The lender goes through an extensive process to determine if the risk of offering you a mortgage loan is acceptable.
The same kind of process happens when you apply for a Medicare Supplement, also called Medigap. There are times when you don't have to go through underwriting – we'll get to shortly. But unless you qualify for those special times, you'll have to go through the medical underwriting process.
While each Medicare Supplement company does things a little differently, the process usually looks like this:
- Talk to your insurance agent about your health, and they'll do something called prequalifying, or comparing your health status and current medications against a company's Underwriting Guide.
- Check your height and weight – almost all Medigap companies have established height, weight, and BMI guidelines.
- Answer a set of 10-20 health questions on the Medigap application.
- Report all of your current prescriptions, including explanations about why you take them.
- Complete a telephone interview.
Some companies have a shorter, smoother process than others. For example, some companies don't require you to list all of your medications on the application – they collect pharmaceutical information themselves.
Overall, underwriting isn't as intimidating as it may sound here, and we guide you through the entire process. It's nothing to stress about.
Common Health Conditions Medigap Carriers Won't Accept
Not all Medigap carriers are the same when it comes to medical underwriting.
Since plan benefits are standardized, the two main differences between Medigap carriers are pricing and underwriting.
You may find one company will accept your health condition, while most others won't. Don't worry: we help with this by taking care of the whole process. Also, don't worry if you have a health condition listed here. Some states have Medigap carriers that don't require underwriting at all. Many times, we have a last resort option. And if we can't find a suitable Medicare Supplement, there's always Medicare Advantage plans which don't require medical underwriting.
The following health conditions are widely considered uninsurable by Medicare Supplement companies:
- Alzheimer's Disease
- Chronic Pain Syndrome
- Chronic Obstructive Pulmonary Disease (COPD)
- Diabetes with Insulin higher than 50 units per day
- Kidney disease requiring dialysis
- Lateral Sclerosis (ALS)
- Lupus – Systemic
- Multiple Sclerosis
- Myasthenia Gravis
- Organ transplant
- Osteoporosis with resulting fractures
- Parkinson's Disease
- Senile Dementia
- Certain cognitive disorders, like delirium or organic brain disorder
- Spinal Stenosis
Some other common scenarios that lead to a decline include using supplemental oxygen, an implantable cardiac defibrillator, using a nebulizer within the last six months, and asthma requiring continuous use of more than two medications.
If you have any pending surgeries, medical tests, or treatments, you'll want to wait to apply for Medicare Supplement coverage. Most applications ask if you have any medical advice you haven't acted on yet.
Other than the height and weight chart and ineligible medications, that's a pretty good look at what Medicare Supplement companies are looking for.
If you don't have any of those conditions, you don't have to be concerned about being declined for Medicare Supplement coverage.
What Happens If I Lie On My Medigap Application?
If you aren't truthful on your Medicare Supplement application, the insurance company will rescind your policy as soon as they find the inconsistency.
All Medicare Supplement companies have something called Denial of Claim/Rescission. That means if they determine your answers on the application were incorrect or untrue, they can deny your benefits or rescind coverage.
Don't lie on an application! The insurance company will find out about it eventually.
Skipping Medigap Underwriting Entirely
There are a few times in your life when you get to Pass Go and Collect $200 if you know what we mean.
Skipping underwriting is a huge opportunity, especially if you have a health condition or perhaps a family history that puts you at risk.
The official terms we're talking about here are called Open Enrollment and Guaranteed Issue.
Open Enrollment allows you to purchase any plan without having to pass any medical underwriting for six months. This only happens once in your life – when you're signing up for Medicare Part B for the first time.
For most people, this is when they're turning 65.
Guaranteed Issue situations occur when something happens to your existing insurance. Some common examples are individuals in a Medicare Advantage Plan who move out of the plan's service area. Another scenario we see is an individual that's working past age 65, and their employer's group health plan is ending. In these circumstances, you have a 63-day window to choose a plan.
Why Choose Wisely?
The coverage decision you make during Open Enrollment or perhaps in a Guaranteed Issue situation is critical.
Open Enrollment is quite possibly the only time in your life where you can bypass medical underwriting and get guaranteed coverage.
If you choose an expensive company during your Open Enrollment, you're stuck there unless you decide to switch carriers. And to switch carriers, you have to go through medical underwriting.
Here's a common scenario: a woman turning 65 soon gets a Medicare Supplement mailer from a well-known company.
She calls that company and signs up for a Medicare Supplement.
That individual never met with an agent, so she never compared pricing across dozens of companies – she only got pricing for that one, brand name company.
A few months after she signs up, she realizes she's overpaying! She now understands she has dozens of companies to choose from, but her doctor just put her on a new medication. She can't pass medical underwriting, so she can't switch companies.
The choice you make during Open Enrollment (or during a Guaranteed Issue situation) is critical. Choose wisely, because you may be stuck there for a long time, if not forever.
Benefits of Going Through Underwriting
Once you're in a Medicare Supplement plan, you'll notice your rates increasing over time. Rates increase for several reasons, including claims experience, inflation, and age.
If you can switch companies and pass their health underwriting questions, you could save hundreds of dollars per year without changing your current coverage.
Here are a few examples:
- David Saves $600/Year on Plan G, Dennis Is Supported After Cancer Diagnosis
- Pam Saves $250 on Plan G, Martha Saves $300 on Plan N
We represent dozens of carriers, and we are not married to any one of them. If you can pass medical underwriting, we can shop the market to ensure you have the most competitive plan available.
Medicare Allies Agents Can Help
When it's time to enroll in Medicare, we're here to help. If you're not sure when your Open Enrollment period is or if you have Guaranteed Issue rights, you have no reason to worry. That's why we're here!
Plus, when we ask you about your health, we already have a good idea of which carriers will accept you, and which carriers we shouldn't waste time on. There's nothing worse than applying for a Medicare Supplement and getting denied. It's a waste of time, and it can be pretty upsetting! We do our best to avoid that, and that's where our knowledge of underwriting can be a huge help.
Bottom line: We weave through the underwriting maze every single day – that's what we're good at! We study Underwriting Guides and work as a team to help our clients find the best coverage at the lowest possible price.
If you're getting ready to turn 65, please contact us to take advantage of your Open Enrollment window! You want an honest, full comparison of the options so you don't get stuck in an expensive plan.
Remember the two main differences between Medicare Supplements: price and underwriting.
The government has standardized Medigap plan benefits across the board, so a Plan G is a Plan G, no matter which company you choose.
If you have any kind of health condition, we'll prequalify you for coverage. And if we run into any hurdles, we'll walk you through all of the available options.
If you're healthy, you have 30+ companies to choose from! Our sophisticated quoting system orders the companies from lowest premium to highest premium, so it's easy for us to determine your best plan.
Even if you already have a plan you love, it never hurts to get a second opinion. There may be a great company offering you the same benefits, but for a lower price.
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