ORIGINAL MEDICARELast Updated on by
Medicare Supplement underwriting questions aren’t always mandatory. Sometimes, like during your Open Enrollment Period, you receive a waiver for health question requirements. If you’re changing a Medigap plan or miss your OEP, underwriting is likely a must.
Medicare Supplement Underwriting Questions
In many states, you need to answer questions about your health and get through underwriting to qualify for new coverage. While medical underwriting can cause some stress, many individuals successfully pass underwriting and change coverage annually, so don’t worry.
Let’s dive into information about the situations typically resulting in approval. Then we can talk about when you may face hurdles changing plans. This information assists you in understanding if you’re Medigap eligible.
Guaranteed Issue Means No Questions about Health
Each beneficiary has a Medigap Open Enrollment Period when turning 65 and first activate their Part B. After Medigap research, you’ll learn the 6-month enrollment window allows you to apply for a supplement without underwriting. Alternative situations are allowing for a policy without underwriting; this is Guarantee Issue rights.
Medigap’s State Birthday Rule
Oregon and California allow beneficiaries to change their supplement policy within the birthday month with no supplement underwriting.
This does require that you have a supplement policy currently active to qualify. Talk to your agent; they can get quotes to check if a lower rate exists.
If you find a good deal, the application process is quick and easy, especially when there are no medical underwriting questions.
Washington allows supplement eligibility all year; this means that anyone could be applying at any time and receive coverage. This also means that rates in Washington for supplements are much higher.
Understanding Medicare Supplement Underwriting Questions
Now you’re an expert with Guaranteed Issue situations! What you need to know is how underwriting is done through the carriers.
Each carrier has a minimum of one form of health-related questions included in its Medigap application.
Some of the questions ask if you’ve EVER had a particular condition; however, others inquire about a more recent time. Commonly, questions about the last couple of years of health history.
Answering NO to a few or all the medical questions as specified on the applications is recommended.
If you answer YES to an inquiry, it can result in an instant decline for most carriers. This means you’re not qualified for any coverage, and there is no need to apply.
Depending on state laws and specific carrier exceptions, it’s best to talk to one of our experts about the possibilities.
Through the next sections, I’ll cover some examples of questions that exist in supplement applications.
Small Health Problems May Result in Approval
When you’re fully healed and done with treatment, then specific injuries are no issue. You will also notice the companies don’t care if the flu got you twice this year or seasonal allergies.
Cholesterol and high blood pressure are unlikely issues when not occurring with a further or more serious problem.
For example, minor arthritis isn’t problematic, but more severe rheumatoid arthritis could indicate a decline in coverage.
The Body Mass Index isn’t as strict on supplement plans as it is with life insurance. Having those few extra pounds isn’t an issue if you aren’t morbidly obese.
Each company has underwriting guidelines, and your broker will company guidelines; this way, you don’t spend time applying when you’d get a denial.
Finish Upcoming Treatments and Pending Surgeries First
There are denial situations, and upcoming procedures are at the top of the list. No company wants to cover you before a costly test or surgery.
Carriers insist that you receive your treatments covered with your previous carrier before applying for new coverage.
Even when your upcoming surgery is not life-threatening, you’ll still need to wait to apply. It’s best to complete your surgery and all follow-up appointments or any required therapy. Once that’s complete, then apply for the new carrier.
Example question from one of our carrier’s applications:
“Within the last 12-months, have you been advised to have treatment, diagnostic testing, further evaluation, or any surgery that hasn’t been performed?”
Some carriers ask about a specific time frame clear post-surgery, like a knee replacement. Since problems are possible, they can ask you to delay the process for the year or more before applying.
These kinds of requirements vary, and it’s best to ask one of our experts which carriers give you the best chance.
Please, Wait if You had Recent Major Services
If you’ve been hospitalized or if you received home health services two more times within the last couple of years, the carrier may decline you during the application. If you live in a nursing home, you most likely won’t be eligible.
People rarely go from a nursing home or assisted living facility to live independently. You may need to keep your coverage indefinitely.
Sample question from a carrier:
“Are you hospitalized, in a nursing facility or assisted living facility, confined to a bed, receiving home health care, or any physical therapy?”
Cancer is a common concern among applicants. Most carriers want to see at least two years of cancer-free and successful remission before they’ll consider covering you. If you’ve had a recent surgery or you are going through any treatments, you’ll want to wait a couple of years before applying.
Keep Your Coverage if you have a Chronic, Incurable Condition
There are plenty of health issues that can be treated but are still considered incurable illnesses. When you have an illness that requires treatment forever, you’ll see that there are questions on many Medicare Supplement applications that can exclude you.
Several common examples include:
- Chronic lung problems
- Dementia
- Immune deficiency disorders like MS, RS, AIDS, or Lupus.
- Nervous system issues, like Parkinson’s
If you have osteoporosis and fractures, this could be problematic. Insurance companies know conditions like this will require a lifetime of care costs.
Heart disorders like this could cause a decline:
- Heart attack
- Stents
- Strokes
- Arterial and vascular diseases
- Pacemakers
- Congestive heart failure
For valve problems and rhythm defects, most carriers will decline coverage. In most circumstances’ organ transplants and kidney failure can indicate a decline.
Medicare Supplement Underwriting Questions for Borderline Conditions
The way a carrier phrases these inquiries on their specific application will determine if you can successfully pass the supplement underwriting.
An example of a common borderline condition would be diabetes and Mental Health.
If you only take the oral medication or you take less than 50 units of insulin, you should receive approval. When you have diabetes, carriers look at additional conditions.
So, if you have high blood pressure and diabetes with high cholesterol or diabetic neuropathy, then it’s harder to receive approval for coverage.
If you only have diabetes and no related conditions, you should be able to change carriers.
Sample question:
“Do you have diabetes with high blood pressure and require three or more high blood pressure medications to maintain control. Does your diabetes require more than 50 units of insulin each day to control?”
Mental conditions can also be a good example. Typically, if you see a therapist and you take a simple anti-depressant, that isn’t an issue when you have a more severe mental disorder that can cause a decline.
Sample question:
“Have now or within the last two years received treatment for (including surgery), or were you advised by a healthcare professional to receive treatment for severe depression, schizophrenia, a paranoid disorder, or bipolar disorder?”
Declined for Medications
Prescription history records are available to Medigap carriers. On your application, you’ll want to allow the new carrier to obtain your prescription records.
You must be truthful and try to remember any of the medications that you were recently prescribed.
Auto-Decline Drugs
Of course, Medigap carriers have a list of medications that indicate automatic denial. These medications are ones that treat chronic or significant illnesses.
If you take these medications, you’re indicating that you have a condition that could be costly to cover. Pain medications can be an issue if used if prolonged.
If you take a small round of a declinable drug post-surgery, the company won’t consider this a problem. If you’ve been using it for years, then that could be a potential issue.
Medical Records
Most people don’t know what’s in their medical record history. Think carefully; if a doctor is telling you that you’re pre-diabetic, you’ll need to ask him what he’s submitting to your file. Was the doctor sugar-coating the health condition during the discussion with you?
Telling you that you’re pre-diabetic is less significant, it’s what exists in your file that is key. If your health chart says diabetes, that’s what the carrier will incorporate in the assessment.
Submitting a Medicare Supplement Application With Underwriting Questions
In the past five years, have you been diagnosed, received treatment for, or take any prescribed medications for:
- Cancer
- Heart Attack or any heart issues such as a Pacemaker or Defibrillator
- Stroke or TIA
- AFIB (Atrial Fibrillation)
- COPD
- Diabetes
- Disabling Arthritis
- Stent Placement
- Prescribed any Blood Thinner medications
- Pending Surgery
Even if you answer yes, this helps our brokers to find the most compatible plan and carrier for your needs. Talking to an expert can make applying for coverage simple.
Identifying the best company for you is simple, and applying is so easy that it can be done over the phone.
Switching supplements is timely, so you should apply for an effective date around 2-3 weeks away. This will give the underwriting department some time to finish your application.
You should expect an underwriter to call you; the telephone interview is a vital part of the carrier’s decision process.
Common Health Issues Medigap Declines
If you have any of the following health conditions, it’s likely a decline will come from your application. Although talking with an agent can help clear the air.
These conditions are usually an automatic decline:
- Aids
- ALS
- Alcohol/Drug Abuse
- Alzheimer’s Disease
- Dementias
- Chronic Bronchitis
- COPD
- Cystic Fibrosis
- Cirrhosis
- Congestive Heart Failure
- Diabetes
- Emphysema
- End-Stage Renal Disease (ESRD)
- Fibromyalgia
- Heart Disease
- Hepatitis
- Immune Disorders
- Multiple Sclerosis
- Lupus
- Kidney Disease requiring dialysis
- Mental/ Nervous Disorder
- Myasthenia Gravis
- Organ Transplant
- Osteoporosis
- Stroke
- Advised to have surgery/ Treatment
- Implantable Cardiac Defibrillator
- Use of supplemental oxygen
- Use of Nebulizer
- Asthma with three or more medications
How to Get Help Understanding Medicare Supplement Underwriting Questions
This is very important; you should never cancel your current coverage before you are approved with your new carrier.
Your agent will notify you so you can contact your previous carrier to end coverage.
Agents can’t cancel your prior coverage, this rule protects you, and you should never assume your agent will cancel previous coverage.
To contact an agent licensed in your area, complete our contact form here. Or, you can call the number above to speak to an agent now. They will be happy to help answer any questions you have regarding your benefits and medical underwriting questions.
About The Author
I currently have Plan N through AARP and seek to mover laterally to another company while retaining Plan N. I am not CHANGING PLANS, just providers. I applied for PLAN N with another insurer and was declined. I pay far more in premiums than they ever pay out for me! I believe if a person is overpaying for a policy with one company they should have the opportunity to simply move to a lower cost provider without underwriting.
Medigap plans are standardized by the federal government. This means all the benefits are the exact same across all carriers, the only difference is the premiums. As long as you pay your premiums, the carrier you’re with cannot deny you coverage due to pre-existing conditions. However, if you want to switch to another carrier, same plan, or a different plan unless you have a Special Enrollment Period, you will have to go through medical underwriting. Even though you want the same plan, you are still switching to another carrier that is new to you and doesn’t know your health history. You could try switching to a different Medigap plan with AARP, in that scenario, they may not require you to go through medical underwriting since you’re already a client. Normally a carrier will accept you into the plan if you’re overall healthy. Did the carrier tell you why you were denied?
Thank you so much. I really appreciate your article as I try and work through this Medicare maze. I live in Florida and am currently enrolled in Medicare Part C insurance through Aetna’s Medicare Supplemental Plan F. I also have a Part D Prescription Drug Plan through WellCare. For cost savings, during open enrollment, I’m thinking of switching to a Medicare Advantage Plan. I understand as part of the “guarantee issue right,” in this first year, I will be able to return to a Medicare supplemental policy and to purchase a Part D plan without any medical questions asked. If this is true, will I be able to return to my original Plan F, since I understand that plan is no longer an option to new enrollees? Also would there be any financial penalty for me if I should switch back?
Hi AnnMarie. Yes, you will be able to use trial-rights to switch back to Plan F as long as it’s within the 12-month time frame. However, make sure your doctors are within the network of your plan. Also, be prepared to have out of pocket costs when you use the benefits. With Plan F, you have 100% coverage. You pay nothing out of pocket outside the monthly premium. Your coverage will be downgraded if you get a Medicare Advantage plan.
My aunt is diabetic and has been taking 40 unit insulin per night, along with oral medications. She is new to Medicare and thinking between keeping original or change to medicare advantage. If she chooses medicare advantage, but later wants to change back to original with a supplement plan. Can she still pass the underwriting health application to have a supplement plan?
Hi Vicky! If she is currently enrolled in a Medigap plan and has been since she was first eligible, then she would be given a trial right. A trial right means you have 12 months to switch back to Original Medicare & pick up a Medigap plan with Guaranteed Issue. However, if she is new to Medicare and never enrolled in a Medigap plan, she would NOT be eligible for a trial right period and would have to answer health questions to change to Medigap at a later time. If she is not yet enrolled in a Medigap plan, but it still in her Medicare Supplement Open Enrollment Period, I would highly recommend she goes with Original Medicare, Medigap, and a Part D plan to make sure she is protected financially. If she cannot afford a Medigap plan, only then would we recommend a Medicare Advantage Plan. I hope this helps!
I have borderline emphyzema with no treatment or meds needed. I have had a heart attack last year. I am on blood thinners, cholesterol and blood pressure meds. I have gout. This is my open enrollment period, is it advisabel to get medigap?
Hi Michael! Yes, I would highly recommend taking advantage of your once in a lifetime Open Enrollment which gives you a Guaranteed Issue Right. This means that none of your previous health conditions will impact your approval or increase your premiums. There’s no cost to you to compare rates in your area. Give us a call so we can help!
Hi. Thanks for the article. I live in North Carolina. This past September I applied for a new Medigap Plan F with lower premiums with the same carrier I already had my Medigap plan with (Aetna) with. I went through the medical underwriting questions with a representative over the phone. When she asked me if I had been diagnosed with osteoporosis within the past 24 months, I said I had been diagnosed with osteoporosis in the past because of a collapsed vertebra (although it was more than 24 months ago), and I have been taking Fosamax for the condition and had no new collapsed vertebrae. They approved me for the new plan. When I received my policy and a copy of the underwriting questionnaire in the mail, I noticed that the Fosamax was not included in the list of drugs I take (although it is the only prescription drug I take). Should I be concerned about that? Does the carrier check medical records before issuing a new Medigap policy? I hope so, because I wanted to be honest and aboveboard with them. I just don’t want any unpleasant surprise in the future, like having my policy rescinded because they thought I had been dishonest!
Hi Dixie! I would not worry about that. Underwriting can pretty much see everything, including your medical records. That drug would not get you declined.
My doctor recommended 49 units of insulin as part of my diabetes treatment. I asked to have it be so that I could get exactly 5 days usage from each Pen. There is no reluctance by my doctor to change the prescription to 49 units. Since the underwriting question uses the word s 50 or more “required” units, am I ok in saying no?
Hi John! If the application says 50 units of insulin or more a week, then you can say no; because you only take 49 units. Although, it’s important to understand that each prescription you fill has a code and if you lie on an application the insurance company will find out. So as long as you’re being honest, you don’t have to worry.