Medicare Supplement Underwriting Explained
When clients start exploring Medicare Supplement (Medigap) plans, one topic that often causes confusion is underwriting. Unlike Medicare Advantage plans, which don’t require medical underwriting, Medigap coverage can involve health-related questions and approval requirements; depending on when and how someone applies. That is why we hope, Medicare supplement underwriting explained will provide an understanding of the process so agents can better assist clients.
What Is Medicare Supplement Underwriting
Underwriting is the process insurance companies use to determine whether to accept an applicant for a Medigap policy, and sometimes the determine the premium amount. This process often involves answering health questions, reviewing prescription history, or even checking recent hospitalizations.
Not every applicant will face underwriting, many people qualify for guaranteed issue rights or are in their Medigap Open Enrollment Period, which means they can get a plan without medical review.
When Is Underwriting Required
Underwriting typically comes into play in these situations:
- Applying outside the Medigap Open Enrollment Period (which lasts six months after a beneficiary first enrolls in Part B at age 65).
- Switching from one Medigap plan to another outside of specific state-mandated open enrollment or “birthday rules.”
- Losing coverage without qualifying for guaranteed issue rights.
In these cases, insurance carriers can:
- Approve coverage at the standard rate,
- Charge a higher premium,
- Impose a waiting period for pre-existing conditions, or
- Deny coverage altogether.
Guaranteed Issue Rights (No Underwriting Required)
There are special circumstances where a beneficiary can enroll in a Medigap plan without facing underwriting, such as:
- Losing employer or union coverage.
- Their Medicare Advantage plan leaving the service area or ending coverage.
- Moving out of a Medicare Advantage plan’s service area.
- Taking advantage of certain state-specific enrollment protections (like California and Oregon’s Birthday Rule, or Missouri’s Anniversary Rule).
During these times, carriers must offer coverage, regardless of health status.
Watch a quick YouTube video on Medicare Supplement Underwriting
Common Health Questions in Underwriting
While exact questions vary by carrier, underwriting often includes:
- Recent heart attacks, strokes, or cancer diagnoses.
- Use of oxygen, dialysis, or organ transplants.
- Height, weight, and mobility concerns.
- Hospitalizations in the past 90 days.
- Use of certain expensive medications.
Carriers typically ask about conditions that are costly and ongoing. Clients with stable, controlled conditions may still qualify.
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Why Agents Should Understand Underwriting
As an agent, knowing the underwriting rules helps you:
- Advise clients on the best time to apply for Medigap coverage.
- Set realistic expectations about approvals, denials, or higher premiums.
- Protect clients by helping them avoid losing a plan they may not be able to requalify for later.
Stay up-to-date on Medicare agent events and information
Underwriting for Medicare Supplements can be straightforward if clients apply at the right time, but tricky if they wait too long or want to change plans later. By understanding the process and knowing when underwriting applies, you can help your clients secure coverage that supports their health and budget without unexpected roadblocks.