There are many benefits to enrolling in Medicare Supplement plans during your open enrollment period. When you do this, you are not asked any questions regarding your health status. However, those who choose to enroll in coverage outside of open enrollment may have to deal with underwriting.
It is important to be aware that you will need to answer basic demographic (not health) questions when you first enroll in a supplement plan. However, there may be times when you must go through underwriting. Underwriting is often required when you decide to switch to a different plan while you are outside of your open enrollment period or OEP.
But what underwriting eligibility questions are you asked for Medicare supplement policies? According to MedicareFAQ, many states require you to answer questions about your health status if you want to obtain new coverage. Although these questions can cause undue stress, many people get through these questions and are able to obtain coverage. It’s only about a 15–20-minute questionnaire; there are no required labs or doctor’s visits.
Medicare supplement underwriting eligibility questions are questions on a Medigap application. Insurance agents utilize the information gained from these questions to determine the price of policies and your eligibility for those policies. However, underwriting eligibility questions are typically only required if one is applying for a policy outside of a Medigap open enrollment period.
Medicare Supplement Underwriting Eligibility Questions are typically not required during a regular open enrollment period. If you are applying outside of your OEP or GI period, you must answer questions that may determine your eligibility. You will likely be asked questions about current health conditions, medications, and conditions you’ve experienced in the past.
There is something called “Guaranteed Issue Rights.” Guaranteed Issue Rights are special circumstances such as losing employment & are used to keep Medicare beneficiaries from being discriminated upon if they have a preexisting condition. During open enrollment, Medicare beneficiaries can apply for benefits during a six-month timeframe without having to answer any underwriting questions.
Medicare beneficiaries can exercise these rights for employer plans when plans supporting Medicare end or if an insurance company files for bankruptcy. These rights may also be exercised if you are “misled” by a Medicare company, experts say.
You will be asked several underwriting questions. You are likely to be asked if you received treatment for or if you were diagnosed with cancer, had a heart attack, or had a stroke. You may also be asked if you have COPD or diabetes, or if you received a stent replacement. An insurance company may also ask if you currently take or were prescribed a certain medication in the last five years.
You may also be asked if you received treatment for or were diagnosed with bipolar disorder, chronic depression, or schizophrenia. The insurance company will also want to know if you have a “history of alcoholism,” or if you are scheduled for an upcoming surgery or diagnostic tests.
Questions and criteria may be different from one state to another and from one company to another, so it may be a good idea to consult with an insurance professional ahead of time. An insurance professional will be able to tell you about state regulations and rules. Saying yes to certain questions can cause you to be denied coverage. Different insurers vary in strictness and a good broker will know which carrier is likely to approve you.
Having certain preexisting conditions can automatically disqualify you for coverage. Conditions that cause people to be denied coverage include congestive heart failure, end-stage kidney disease, chronic bronchitis, alcoholism, and mental or nervous system disorders. Lupus is another condition that may disqualify you from receiving coverage.
Criteria for Medigap denial varies from state to state, so it’s a good idea to do your research to see how your state’s laws affect your ability to secure a Medigap policy. Your insurance company may also do something called prequalifying. With prequalifying, your insurance company will check your medications and your health status.
The insurance company will use this information and see how it applies to the company’s Underwriting Guide.” Medigap companies also take into consideration your height, body mass index (BMI), and weight to determine your suitability for a plan. You will be required to answer 10 to 20 questions on your application. Insurance companies have established guidelines for these.
You must list all prescriptions you are currently taking and your reasons for taking them. You will also need to have an interview over the phone. Some companies are not as strict as others. According to Medicare Allies, there are other conditions that Medigap will not cover.
Medigap companies will not accept or cover chronic conditions, such as Alzheimer’s Disease, HIV/AIDS, Chronic Pain Syndrome, cirrhosis, or emphysema. Those with Parkinson’s Disease, dementia, and multiple sclerosis are unable to obtain coverage. Additionally, those awaiting an organ transplant may also be disqualified.
Some brain problems, such as organic brain disorders, are uninsurable by many insurance company standards. Those with Myasthenia Gravis and spinal stenosis may also not qualify for coverage. If you don’t have these conditions, chances are you have nothing to worry about. However, some people may lie on their application.
What happens if you lie on your application? If you lie on a Medicare supplement application, your company may revoke your coverage as soon as they become aware of your untruth. However, honesty is the best policy. Never lie on an application. If you want to avoid underwriting entirely, it is a good idea to enroll during your open enrollment period. If this is not possible, be aware that the insurance company is going to delve deep into your medical history to determine whether you are a risk.
Your open enrollment happens only once in your life. During open enrollment, you cannot be asked about your health history or preexisting conditions. Most people have open enrollment as soon as they turn 65. This enrollment period lasts for a total of six months from the time you apply for Original Medicare part B and are 65+.
Insurance companies don’t ask the same set of questions as other insurance companies, but if you have certain health conditions, the insurance company needs to know about past diagnoses, medications, and tests you have received. You may not think that all your medical information is relevant in determining your eligibility for insurance. However, insurance companies need to know all these details. The insurance company, in underwriting, will pull your medical records in making a final decision cross-checking the provided information with records.
You must disclose all this information on your application. Most people have small health problems from time to time. As long as these are corrected with treatment, you have no reason to worry about being denied coverage. Having seasonal allergies or getting the flu a few times in one season is not going to impair your ability to get coverage.
You may be able to get coverage if you have some small health problems. High blood pressure and high cholesterol are not significant enough to keep you from obtaining coverage. Some people may worry about arthritis causing problems in getting coverage, but this is not a big deal.
Body mass index typically has a large impact on those applying for life insurance, but such is not the case with a Medigap supplement policy. However, those who have rheumatoid arthritis may find that their coverage is declined.
In terms of weight, insurance companies don’t care if you’re carrying around a little extra weight, but morbid obesity can pose a problem. Every company has its own guidelines when it comes to underwriting. If you familiarize yourself with these guidelines, you will understand why you are approved for or denied coverage after applying.
If you know you are going to get denied by a company, there is no point in applying to that company. If you want to avoid a denial in coverage, it is a good idea to take care of upcoming surgeries and finish ongoing treatments before applying. Also, be sure to keep yourself in the best possible health.
Insurance providers suggest that you take care of existing issues before you apply for coverage. Because of this, it is a good idea to take care of unfinished treatments first. This will avoid any future problems you could encounter. When you have taken care of surgeries and treatments, you can then apply to carriers. At this point, you are more likely to be offered coverage by an insurance company.
If you have recently had any major treatments or medical procedures, it is best to hold off on applying for coverage, at least for a little while. Receiving home health services within the past few years can put off insurance companies who may see this as a red flag. As a result, you may be denied coverage.
Those who live in nursing homes are unable to obtain this type of coverage. It is rare that those living in nursing homes or retirement communities return to living life on their own. If you already have some type of coverage, it is a good idea to keep it.
Cancer is a concern for many people and insurance companies. If you have had cancer and want to apply for a policy, it is a good idea to be cancer-free for two years before you apply for coverage. If you are receiving ongoing treatments related to a condition, such as cancer, it is best to hold off on applying for a while.
6 Sources
MedigapCoverage has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.
https://www.medicarefaq.com/faqs/medicare-supplement-underwriting-questions/
https://www.helpadvisor.com/medicare-supplement-underwriting-questions
https://www.bcbsm.com/medicare/help/faqs/works/supplement-plans-cover.html
https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772