September 27th 2023
By Ari Parker
Learn about what Medicare medical underwriting is, what it entails, and how it relates to Medicare Supplement enrollment.
When you first enroll in Medicare Part B, you unlock the Medigap Open Enrollment Period, which allows you to enroll in any Medicare Supplement plan without going through medical underwriting. But what exactly is medical underwriting, and how does it work when you enroll in a Medicare Supplement plan? In this guide, we’ll explain what medical underwriting is, what it entails, and how it relates to Medicare Supplement enrollment.
Note: Medicare Supplement plans are often also called Medigap plans, and we use the two terms interchangeably.
Medical underwriting is when insurance companies try to determine your health status by asking questions about your health history. They do this to decide if they should accept your insurance application, what price they should charge, and what limitations they should implement.
You’ll encounter questions about your health history on your Medigap application. Each insurance company has its own application, but you’ll generally see at least one page of questions about your health.
Most applications have questions about any ongoing health conditions. For example, you may be asked if you’ve been diagnosed with or received treatment for a number of conditions, including cancer, heart conditions, diabetes, osteoporosis, a stroke, and others. These questions may ask specifically about diagnoses and treatments in the past few years or within your lifetime. You will also be asked about your weight, blood pressure, and prescriptions.
If you answer no to all of the questions, you should be granted Medigap coverage. Depending on the severity of your health condition(s) and the leniency of the insurance company you submit an application to, you may be granted coverage even if you have a pre-existing condition.
Medigap has specific guaranteed issue periods during which insurance carriers cannot ask you questions about your health history and cannot deny you Medigap coverage or charge you more based on your health history. Outside of these guaranteed issue periods, insurance companies may require medical underwriting and can deny your Medigap application.
The primary guaranteed issue period, which every Medicare beneficiary has access to is the Medigap Open Enrollment Period. This is a six-month period that starts after your Medicare Part B effective date. (If you enroll in Medicare under the age of 65, your Medigap Open Enrollment Period will occur when you turn 65. At that point you can enroll in a Medigap plan for the first time or switch Medigap plans without medical underwriting.)
We cover the details of other guaranteed issue periods in our Medigap enrollment guide.
Some states have special Medigap enrollment rules that provide added guaranteed issue protections to make Medigap enrollment more flexible. Learn about the specifics of each state’s rule by clicking the link to the state’s Medicare guide.
States with continuous or annual guaranteed issue protections:
States with birthday rules, which allow you to switch from one Medigap plan to a plan with equal or lesser coverage during a specific period around your birthday:
Finally, Missouri has a Medigap anniversary rule, which allows you to switch to the same Medigap plan with a different carrier 30 days before and 30 days after your birthday.
If you’re interested in enrolling in Medigap or switching Medigap plans, we’re here to help! We’ll ensure you have the information you need to make the right decision for your needs and avoid costly mistakes.
Schedule a free consultation or call us at (855) 900-2427 to get your questions answered and feel confident in your Medicare decisions.
Can you switch from Medicare Advantage to Medigap without going through medical underwriting?
You can change from Medicare Advantage to Medigap without medical underwriting if one of the following occurs:
Your Medicare Advantage plan withdraws from where you live
You move to a new area that’s not covered by your Medicare Advantage plan
You disenroll from a Medicare Advantage plan within a year of either canceling your Medigap plan to join a Medicare Advantage plan or enrolling in a Medicare Advantage plan during your first year on Medicare.
Can you change Medicare Supplement plans without going through medical underwriting?
Generally, the same enrollment rules apply for either enrolling in a Medicare Supplement plan for the first time or switching between Medicare Supplement plans. States with birthday and anniversary rules grant limited exceptions.
