Last updated on May 26th, 2022

Medicare Supplement underwriting questions help carriers get a better understanding of the beneficiary seeking coverage. Sometimes, Medicare Supplement underwriting is mandatory to enroll in a plan. However, this is not always the case. Some situations do not require underwriting health questions.

Below, we discuss underwriting health questions and when they are applicable. We also review everyday situations to avoid that may result in policy denial.

What Are Medicare Supplement Underwriting Questions?

If you apply for a Medicare Supplement plan outside of your Open Enrollment Period, you may need to answer underwriting health questions. These questions determine whether an insurer is willing to assume your risk and allow you to enroll in their Medicare Supplement plan.

Carriers do not need to ask standardized Medicare Supplement underwriting questions. Each carrier has its own list of questions to determine your insurability. Thus, if one company denies you coverage, you may still have other options.

Additionally, underwriting health questions do not change based on the Medicare Supplement plan you choose. Carriers streamline their questions to be identical regardless of your plan choice.

Because Medicare Supplement (Medigap) plans benefits kick in after Original Medicare pays their part, carriers are more cautious of the beneficiaries whose risk they assume. If the insurance company decides you are too much of a risk to take on, they can deny you coverage based on your current or previous health.

If you believe your health may raise an issue with an insurance carrier, it is essential to work with an agent who has access to multiple carriers. This way, you will have the greatest chance to enroll with a carrier who will approve your application.

When is Medicare Supplement Underwriting Used?

Carriers use Medicare Supplement underwriting anytime you apply for Medicare Supplement coverage and do not have guaranteed issue rights. This means that if you are outside of your Medicare Supplement Open Enrollment Period, did not experience a qualifying life-changing event, or your state does not have special rules, you will be subject to answering Medicare Supplement underwriting questions.

On the contrary, if your state has special rules, you experience a qualifying life-changing event, or if you are within your Medicare Supplement Open Enrollment Period, you can enroll in a Medicare Supplement plan without answering underwriting questions. It is essential to apply for a Medigap plan during these times because you will be eligible for any available plan.

Standard Medicare Supplement Underwriting Declinable Pre-Existing Conditions

Certain pre-existing health conditions are considered declinable or significant health risks for several Medicare Supplement insurance carriers. However, each company has different timelines as to how far back in your medical history they check.

Common declinable conditions include:

  • Cancer
  • Heart attack
  • Stroke
  • Atrial fibrillation
  • COPD
  • Diabetes
  • Dementia
  • Immune deficiency disorders
  • Nervous system disorders
  • Heart failure
  • Mental illnesses
  • Pending tests/surgery
  • Disabling arthritis
  • Kidney disease

This list is not all-encompassing, and even if you answer yes to any of these questions, you may be admitted to a plan with the right carrier.

Pre-existing conditions are not the only factor when insurers consider your answers to Medicare Supplement underwriting questions. The drugs you take may also affect your enrollment eligibility. Specific medications, especially some blood thinners, cause applications to be declined.

What to Do if Your Medigap Application is Declined Due to Underwriting Questions 

If you are enrolling in a new Medigap plan, it is imperative to keep your current coverage until the new carrier accepts your application. If you disenroll from your current plan and are denied coverage due to underwriting, you will be unable to re-enroll in your original plan.

If you apply for a Medicare Supplement plan and your application is denied due to Medicare Supplement underwriting, you may have other options. Brokers who work with several carriers can help you find the cause of the decline and may find a more lenient company for your coverage.

Sources:

  1. When can I buy Medigap, Medicare . Accessed May 2022.
    https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap