What is Medical Underwriting and Do You Need It?
You may be one of the many Americans who’ve had Medicare for a while and realize you need help with the coverage gaps in Part A and Part B. A Medicare supplement plan will be something you want to look into, but we want you to know that approval isn’t guaranteed. If you let your Medigap Open Enrollment Period pass without signing up for a policy, you may be subject to what’s known as medical underwriting. Other situations in which you may face this are if you’re switching from one Medicare supplement plan to another or switching from a Medicare Advantage plan to a Medigap policy. This potential “monkey wrench” might look like a problem, but it could end up helping you find the best plan for your health and your budget.
What exactly is underwriting?
When insurance companies want to calculate a cost for your coverage, they can compile information from your medical history to predict what kind of a risk it’s going to be to cover you. This is known as medical underwriting. People who have long records of health issues will likely face higher premiums for their policies, if they get covered at all. Carriers can require a waiting period if you have a pre-existing condition such as an injury or disease — or deny you outright.
How does the pre-existing condition waiting period work?
As a rule, enrolling during your Medigap Supplement Open Enrollment Period means that insurers can’t delay your start of coverage. Sometimes though, you can be hit with a pre-existing condition waiting period which requires you to cover all out-of-pocket expenses for your pre-existing condition for up to 6 months. If you can show proof of at least 6 months of “creditable” coverage prior to applying for a Medigap plan, you might be able to cut short or avoid entirely the pre-existing condition waiting period.
How can I be protected from underwriting?
While you’re in your Medigap Open Enrollment Period, you have what are known as “guaranteed issue rights.” These are a series of situations, which allow you to avoid medical underwriting and thus buy a Medigap plan regardless of your health history. You have a right, for example, if you have a Medicare Advantage plan and it’s moving from your service area, or you have Medicare Part A or B and an employer-sponsored health plan that picks up what Medicare doesn’t cover, and that plan is ending.
Should I be concerned about underwriting?
The people who are vulnerable to medical underwriting either have chronic or incurable conditions, are smokers, or have a pre-existing condition. It’s still possible for these people to avoid being delayed or denied coverage (and not just possible, but simple). All they have to do is make sure to enroll in a Medicare Supplement plan during their Medigap Open Enrollment Period. This starts when you’re 65 and in Part B, and lasts for 6 months. medigapcoverage.com powered by pollen has underwriters ready to simplify an often challenging process at 1-833-245-0614 and answer your questions. We know the territory and can walk you through it with confidence.
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When an insurer wants to figure out what it’s going to cost to cover you, they can compile information from your medical history to predict what kind of a risk it’s going to be.
I’m a smoker and I’m worried about getting denied coverage once I enroll in Medicare. Is there anything I can do?
The only way to avoid medical underwriting is to enroll in a Medicare Supplement plan during your Medigap Open Enrollment Period. This starts when you’re 65 and in Part B, and lasts for 6 months.
While you’re in your Medigap Open Enrollment Period, you have what are known as “guaranteed issue rights.” These are a series of situations, which allow you to avoid medical underwriting and thus buy a Medigap plan regardless of your health history.
- Best overall Medicare supplement for new enrollees: Plan G.
- Best overall Medicare supplement before 2020: Plan F.
- Best low cost Medicare supplement: Plan K.
- Best alternative to Plan G Medicare supplement: Plan N.
Medicare Supplement policies are private health insurance designed to cover gaps in Original Medicare. They are also known as Medigap plans. These take care of costs such as copays, coinsurance, and deductibles which can become expensive if you need regular care from a doctor or hospital. If you need medical care while traveling outside the U.S., you can buy Medigap policies to help cover those costs. As a supplement to Original Medicare, you’re required to have Part A and Part B before you canget a Medigap policy. This way, Medicare is responsible for the Medicare-approved costs of the covered care, and the remainder is covered by your Medigap plan.
Optimal coverage comes with higher costs, making Plan F the most expensive Medigap plan. Plan F is known as “first-dollar coverage” and it takes care of everything provided during a doctor or hospital visit. Your only responsibility is for dental, vision, medications, and equipment, such as hearing aids.
The Federal government ended the Plan F option for new enrollees last year to keep the healthcare system from being overused by patients who had their deductibles covered. The next best coverage after Plan F is Plan G.
Medigap Plan G offers every advantage of Plan F except for the deductible, which you have to cover. Because it isn’t as comprehensive as Plan F, Plan G is more affordable.
For people who don’t go to the doctor often, Plan K is worth considering. It is the most affordable because it provides just 50% of Medicare Part B coinsurance, the Part A deductible, blood, skilled nursing, and Part A hospice costs. For comparison, Plan G and others offer full coverage of these expenses, and more.
It’s hard to argue against plans which cut your traditional Medicare costs. For most people, having the extra coverage these supplemental plans provide is common sense, unless they want the specific features of a Medicare Advantage plan.
Most people would benefit from not having to pay out-of-pocket to stay healthy. Medicare supplement insurance or a Medicare Advantage plan offer vital savings now, but are indispensable should a catastrophic health issue occur.
Of the 10 Medicare-approved Medigap plans, Plan G and Plan N are the most popular. Plan F is no longer available to new Medicare enrollees as of 2020, but it is still popular among people who bought this plan prior to 2020.
- Plan F$128–$342
- Plan F (high deductible)$22–$88
- Plan G$106–$325
- Plan G (high deductible)$29–$58
Before getting a Medicare supplement plan, you need to be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). People with Medicare Advantage Plans who want to go back to Original Medicare can buy a Medigap policy prior to switching.
The security of having lower or no out-of-pocket healthcare costs can offset the premiums you’ll have to pay for whichever Medigap plan you choose, which vary depending on the benefits offered.
The national average cost for Medicare Supplement Plan F is $1,824 annually, which is $152/month; Medigap Plan G will cost you around $143 per month.
Since Plan F was discontinued for new enrollees as of 2020, Plan G offers the most coverage for people 65 and older. It has a lower premium than Plan F and duplicates its benefits, except for the Part B deductible.
It depends on your specific needs, but for most people a Medigap plan is very useful in supplementing the coverage of Medicare Part A and Part B. A Medicare Advantage plan is an affordable way to get healthcare coverage not offered by Original Medicare.
Historically, Plan F has been the most popular because it covers all the out-of-pocket costs Medicare does’t pay for. This includes the 15% extra charge billed by providers who do not take Medicare as full payment.