Senior Healthcare Direct

Medicare Supplement Insurance Underwriting

Medicare Supplement Insurance without Underwriting

medicare supplement insurance underwriting

Medicare Supplement insurance underwriting is NEVER required when you are first eligible and Apply for Medicare during your initial Open Enrollment Period (OEP). This is a 7-month period: 3 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 your health condition during this period. In other words, you can have health conditions and your coverage will NOT be denied. 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?

  • 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, then 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 Medigap Plan without underwriting: 30 days before your birthday, on day of birth, and 30 days after your birthday. In addition, 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 is no medical underwriting questions.

Likewise, in the state of Washington Medicare beneficiaries can shop Medigap

How To Switch Medigap Plans

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

No physical or labwork is necessary to switch to Medigap plans. Answering health questions and an underwriting interview over the phone is all that is required to switch Medicare Supplement Plans. In the video below, Robert Bache shows 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. Medigap policies are sold by private insurance companies. As a result, some 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 median weight is 198 pounds. The median American female height is 5 foot 4 inches and median weight is 170 pounds. If your weight is normal and you have no health conditions, then you will have no problem qualifying for health insurance. On the other hand, if you are underweight or overweight (obese), you can still qualify for health insurance coverage with increase in premium. However, if you are severely underweight or severely obese, then you will be denied by Medicare Supplement insurance underwriting. For height and weight guidelines, use the Body Mass Index chart below:

Body Mass Index chart

Acccording to Body Mass Index (BMI) chart above, the median American male and female has BMI of 29. Therefore, the middle value of all Americans bodies is overweight and almost obese. In fact, the Centers for Disease Control and Prevention (CDC) reports the percent of adults age 20 and over with overweight including obese is 71.6%. If your BMI is 19 to 24 (optimal), then you are normal weight and will pass Medicare Supplement insurance underwriting. In addition, you may qualify for health coverage with 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. Any applicant with 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 including: eating, toileting, bathing, and dressing. In addition, underwriting will ask you questions about other instrumental activities of daily living. For example, underwriting may ask about activities such as shopping, meal preparation, housework, laundry, and taking medications. If you are unable to perform these daily living activities without assistance, then you will not be approved by Medicare Supplement insurance underwriting.

Do you have any of the following health conditions?

Anyone with a chronic, incurable health condition may be disqualified 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 must be administered in a physician’s office

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 coverage for 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, your case is considered well controlled and insurable if you take no more than two medications (two for diabetes and two for hypertension). Furthermore, hypertension is considered stable if recent average blood pressure readings are 150/85 or lower. A well-controlled diabetes and hypertension case can be approved by Medicare Supplement insurance underwriting.

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 be asked to list all the medications you have taken over the last two years. Moreover, the Medicare Supplement insurance company uses a underwriting system called Gen Re to look up all your prescription from pharmacies.

There is a very long list of medications which 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. On the other hand, osteoporosis a disease resulting in low bone density is a chronic condition. As a result, bones become more fragile over time and the risk of fracture is greatly increased. When applying with Mutual of Ohama to switch Medigap plans they ask, “Do you have Osteoporosis, and as a result, experienced a fracture?” Thus, if you had fractures from Osteoporosis, the you will be denied coverage.

In general, you can apply for Medicare Supplement insurance with an acute health condition and pass underwriting.

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 labwork, it needs to be completed before you apply. In addition, physical therapy will need to be completed as well. Thus, you will need to complete the surgery and any follow-up visits or therapy before you apply.

Other Ways Underwriting Denies Coverage

Even after 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 2 or more times in the last 2 years. Likewise, coverage will also be denied if you are living in a nursing home. 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 2 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, it is important you give correct information. After speaking with a licensed agent at Senior Healthcare Direct, the policy is processed by our customer support team. To speed up the process our customer support team does a followup interview with the insurance underwriter. For example, you can avoid policy delays by giving the correct spelling of your last name as it appears on your Medicare card. In addition, 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 customer support team member Tammy Hess in the video below.

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