Pen and Insurance Application

Medicare Supplement Underwriting

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Are you looking to purchase a Medicare Supplement, but you’re concerned about the underwriting requirements? Obviously, the best time to buy a Medigap Plan is during your Initial Enrollment Period (IEP). However, there are circumstances when you may need a plan outside of your IEP. Such as, changing plans for more or less coverage, or saving money by avoiding rate increases.

There isn’t any standard Medicare Supplement underwriting guideline. Each company uses their own and varies widely in their standards.

Some companies regardless of whether or not you are in an open enrollment period will issue you a plan without any underwriting. You want to avoid these types of plans. Guarantee issue Medigap Plans tend to have a larger amount of policyholders who can’t obtain insurance anywhere else because of their health. Making significant rate increases a high probability.

Most companies will ask health questions looking back at 2-3 years. Others will only look back 90 days while others go as far back as 5 years.

Along with look-back questions, companies also have what are commonly called knockout questions. Knockout questions ask about critical or terminal conditions that regardless of the time-frame will eliminate you from coverage.

Your best option is to speak with an insurance agent who is familiar with the various underwriting standards of the different companies.

Even if you are sure you will qualify, do not cancel your old plan until you are issued a new one. By doing this, you will avoid any gap in coverage, along with the risk of losing coverage permanently.

Here are some typical Medigap underwriting questions.

Within a specific time-frame (depending on the company), have you had or been advised to have treatment for

  • Coronary artery disease, angina, heart attack, cardiac angioplasty, bypass surgery or stent placement?
  • Cardiomyopathy, Congestive Heart Failure, aortic or a cardiac aneurysm, peripheral vascular disease, vascular angioplasty, endarterectomy, carotid artery disease, heart or heart valve disorder, atrial fibrillation, other heart rhythm disorder, or implantation of a pacemaker?
  • Alcoholism or drug abuse?
  • Any mental or nervous disorder requiring treatment (including hospital confinement) by a psychiatrist, psychologist, counselor or therapist?
  • Internal cancer, lymphoma or melanoma?
  • A stroke or transient ischemic attack (TIA)?
  • Degenerative bone disease, spinal stenosis, rheumatoid arthritis, psoriatic arthritis, arthritis that restricts mobility or have you been advised to have a joint replacement?
  • Have you been advised by a medical professional that surgery may be required within the next 12 months for cataracts?
  • Have you been hospital confined three or more times in the past two years for a same or similar condition?

A phone interview is very common among insurance companies.

In general, they will just verify the questions on the application that your agent has already asked.

If you have questions concerning specific health conditions and your insurability, contact Medigap Planners. Using our Medicare Supplement database, we can perform a search based on underwriting questions. If there is a Medigap Plan that will accept your condition, we can find it.

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