Senior Healthcare Direct

Medicare Supplement Insurance Underwriting

Medicare Supplement Insurance without Underwriting

Medicare Supplement Insurance Underwriting happy senior couple
Happy seniors enroll in Medigap plans at age 65.

Medicare Supplement insurance underwriting is NEVER required when you are first eligible and Apply for Medicare during your initial Open Enrollment Period (OEP). This 7-month period includes three months before you turn 65, the month you turn 65, and 3 months after you turn 65. As a result, you can NEVER be disqualified for coverage based on health conditions during this period.

In other words, you can have health conditions and buy whatever Supplement Plan you want. Moreover, the plan can NEVER charge more if you have health issues during OEP. When you apply for Medicare during this period, your acceptance into a Medigap Plan is guaranteed. According to Medicare.gov, the best time to buy a Medigap policy is during your open enrollment period.

When is Medigap insurance underwriting required?

You will need to answer health questions in the following cases:

  • If the first time you enroll in Medicare Supplement Plan is AFTER your initial Open Enrollment Period, Medigap underwriting is required. In other words, you did NOT apply for Medicare during your initial OEP.
  • When you switch to a different Medigap Plan after your initial Open Enrollment Period, underwriting is required.
  • Likewise, when you switch from Medicare Advantage Plan to Medigap Plan after your initial OEP, then underwriting is required.

Medigap State Birthday Rule

Medigap State Birthday Rule

In Oregon and California, Medicare beneficiaries can shop Medigap Plans within 30 days a birthday month with no underwriting. Specifically, you have a total of 61 days to enroll in a Medigap plan without underwriting: 30 days before your birthday, the day of birth, and 30 days after your birthday.

Furthermore, applicants must have an existing Medigap policy in place. Senior Healthcare Direct can help you shop and save on Medicare Supplement Plans by calling 1-855-368-4717 or get you quote. When you find a plan you want, applying is fast and easy because there are no medical underwriting questions.

How To Switch Medigap Plans

Robert Bache, the Senior Healthcare Direct founder, says, “Switching your Medigap plan has never been easier. It takes about 15 minutes, and you can do it right over the phone.” Call 1-855-368-4717 to speak with a licensed agent and save money on your Medicare Supplement plan.

No physical or lab work is necessary to switch to Medigap plans. Answering health questions and an underwriting interview over the phone is all that is required to change Medicare Supplement Plans. When your application is approved, the insurance provider may charge you an application fee.

In the video below, Robert Bache covers application questions asked by Mutual of Omaha to qualify for their Medigap plans.

Underwriting Questions For Medigap Policies?

Anytime you apply for Medicare Supplement Plan (Medigap) outside your initial Open Enrollment Period (OEP), you will have to answer underwriting questions. Private insurance companies sell Medigap policies. As a result, some of the underwriting questions insurance carriers ask will be different. However, many insurance companies ask similar questions. The following are the most common underwriting questions:

What is your height and weight?

The median (middle) American male height is 5 foot 10 inches, and the median weight is 198 pounds. The median American female height is 5 foot 4 inches, and the median weight is 170 pounds. If your weight is normal/healthy and you have no medical conditions, you will have no problem qualifying for health insurance.

On the other hand, if you are underweight or overweight, you can still qualify for health insurance coverage with a premium increase. However, if you are severely underweight or severely obese, you will be denied by Medicare Supplement insurance underwriting. For height and weight guidelines, use the Body Mass Index chart below or BMI calculator:

Body Mass Index chart

According to Body Mass Index (BMI) chart above, the median American male and female have a BMI of 29. Therefore, the middle value of all American bodies is overweight and almost obese. The Centers for Disease Control and Prevention (CDC) reports that 42.4% of adults have obesity (2017-2018). 

If your BMI is 19 to 24 (optimal), you are normal-weight and will pass Medicare Supplement insurance underwriting. Furthermore, you may qualify for health coverage with a BMI of 17 to 18 (underweight) or BMI of 25 to 35 (overweight to middle obese) depending on other health conditions.

However, you may not qualify for health coverage with a BMI over 35 when you have other health conditions. Moreover, any applicant with a BMI of 40 or higher (severely obese) will not pass Medicare Supplement insurance underwriting.

Do you require assistance for activities of daily living?

Underwriting may ask you questions about activities of daily living (ADL): eating, toileting, bathing, and dressing. Furthermore, underwriting will ask you questions about other instrumental ADLs. For example, underwriting may ask about shopping, meal preparation, housework, laundry, and taking medications. If you cannot perform these daily living activities without assistance, Medicare Supplement insurance underwriting could deny you coverage.

Do you have any of the following health conditions?

Anyone with a chronic, incurable health condition may not qualify for health coverage. Medicare supplement applications have a long list of health condition questions, including the following:

hypertension chronic health condition
High blood pressure, also called hypertension, is a chronic condition that if not properly managed can lead to heart disease and stroke.
  • Any cardio-pulmonary disorder requiring oxygen
  • Implantable cardiac defibrillator
  • Chronic Hepatitis B, C, D
  • Chronic Kidney/Renal Disease
  • Dementia and other cognitive disorders
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Immune deficiency disorders like MS, AIDS, or Lupus
  • Nervous system conditions, such as Parkinson’s
  • Taking any medication that a doctor’s office must administer

Coverage For Well-Controlled Diabetes and Hypertension

These chronic health conditions and other related conditions will disqualify you for health coverage. However, Medigap insurance company (Mutual of Omaha) may consider insuring people with diabetes and hypertension who have well-controlled cases.

For example, if your diabetes or hypertension had no changes in treatment or medications for at least two years, then your case is well-controlled. Moreover, a well-controlled case is insurable if you take no more than two medications (two for diabetes and two for hypertension). Furthermore, hypertension is stable if recent average blood pressure readings are 150/85 or lower.

Medicare Supplement insurance underwriting can approve well-controlled diabetes and hypertension cases. On the other hand, if you have diabetes (insulin-dependent or treated with oral medication) and have one or more complicating conditions, you will not be eligible for coverage. For example, complications include:

  • Eye or vision problems
  • Numbness or tingling in the toes or feet
  • Circulation problems or pain in the legs

Do you take any of the following medications?

When you apply for Medigap coverage, you will need to list all the medications you have taken over the last two years. Moreover, the Medicare Supplement insurance company uses an underwriting system called Gen Re to look up all your pharmacy prescriptions. There is a very long list of medications that can disqualify your application.

In general, these are drugs people take for chronic and incurable conditions. Some of these uninsurable medications include:

medicare supplement insurance underwriting
  • Alzheimer’s / Dementia drugs such as Cognex
  • Cancer drugs such as Lupron and Zoladex
  • Rheumatoid Arthritis drugs such as Methotrexate more than 25mg/wk
  • Opioid (narcotics) such as Fentanyl
  • Insulin more than 50 units per day for diabetes
  • Prednisone (corticosteroid) more than 10mg per day

Acute Health Conditions Will Pass Underwriting

Acute health conditions appear suddenly and often last a short time. For example, getting a cold or the flu may only last a few days. Furthermore, a broken bone, seasonal allergies, or urinary tract infection are acute conditions as well. In general, you can apply for Medicare Supplement insurance with an acute health condition and pass underwriting.

On the other hand, Osteoporosis, a disease resulting in low bone density, is a chronic condition. As a result, bones become brittle, and fracture risks increase over time. When applying with Mutual of Ohama to switch Medigap plans, they ask, “Do you have Osteoporosis, and as a result, experienced a fracture?” If you had fractures from Osteoporosis, Mutual of Ohama would deny coverage. Please read the article, Does Medicare Cover Prolia?, and learn about Medicare coverage for this Osteoporosis drug.

Finish Pending Surgeries and Treatments Before You Apply

Medicare Supplement insurance underwriting will deny coverage if an applicant has a pending surgery or treatment. For example, if you have an upcoming test/procedure or lab work, it must be completed before you apply. Please complete any surgery and any follow-up visits, including physical therapy, before you apply.

Other Ways Underwriting Denies Coverage

Even after your surgery is complete, some Medicare Supplement insurance underwriting may require a waiting period. For example, after major surgery such as knee replacement, the waiting period could be a year or two.

Furthermore, underwriting can deny coverage if you are receiving home health care or have been hospitalized two or more times in the last two years. Likewise, living in a nursing home can also disqualify you. A commonly asked application question:

Are you currently hospitalized, confined to a bed, in a nursing facility or assisted living facility, receiving home health care or physical therapy?

By answering yes to the above question, underwriting will deny coverage. Another health condition people ask about is cancer. Most Medigap underwriting requires two years of cancer-free (in remission) before they approve coverage.

Underwriting may deny coverage based on mental health conditions. An application question may ask:

Do you now or in the last 2 years been treated for (including surgery) or advised by a medical professional to have treatment for major depression, bipolar disorder, schizophrenia, or a paranoid disorder?

Chronic mental disorders can cause Medicare Supplement insurance underwriting to deny coverage. However, seeing a therapist or taking a mild anti-depressant would pass underwriting.

How to Avoid Medicare Policy Delays

To avoid Medicare policy delays, please provide correct information. After speaking with a licensed agent at Senior Healthcare Direct, the customer support team processes the policy. To speed up the process, our customer support team does a follow-up interview with the insurance underwriter.

For example, you can avoid policy delays by giving your last name with correct spelling as it appears on your Medicare card. Also, more information may be required from your doctor to get your application approved. For an inside look at the underwriting process, watch Robert Bache interview Tammy Hess in the video below.

Read More: Medigap Mondays – Medicare Supplement Plans (Medigap)