How to Ace Your Medigap Plan Medical Underwriting Questions and Get the Best Medicare Supplement Insurance Plan
Do you know how to answer the questions your insurer asks?
With over a dozen types of medical insurance plans available on the market, it can be hard to figure out which one is best for you. One thing that is vital in choosing an actual plan is understanding what each policy covers and outlining its benefits so that you don’t get blindsided by expenses.
But knowing all this information might not make getting coverage as easy as picking up the phone and having a chat with your agent or provider.
In order to get the best Medigap policy for you, here are some tips on how to ace your underwriting questions: Policy for You
Table of Contents
How Can I Pass the Medicare Supplement also known as Medigap Medical Underwriting?
Underwriting is the process that insurance companies use to determine whether or not to approve an applicant for coverage. Medigap Insurers will look at several factors when making their decision, including your medical history, lifestyle, and any pre-existing conditions you may have.
What questions will be asked:
Insurance companies will ask you a series of questions about your health and lifestyle in order to determine if you are a good risk for them to insure. They may also ask for information about your family medical history and any pre-existing conditions you may have.
How to prepare for underwriting:
There are a few things you can do to prepare for your Medigap underwriting questions. First, it is important that you have a clear understanding of your health and any pre-existing conditions you may have.
You should also be prepared to answer questions about your lifestyle and family medical history. Finally, it is always helpful to have copies of your most recent medical records on hand when meeting with an insurance company representative.
What to do if you are denied:
If you are denied coverage by an insurance company, there are a few options available to you. First, you can appeal the decision to the company itself. If that is unsuccessful, you can contact your state’s insurance department to file a complaint. Finally, you can purchase a Medigap policy through the federal government’s Medicare program by reaching out to one of our licensed insurance agents.
Why are their Medicare Supplement Underwriting Questions when Medicare Advantage Plans Don't have Underwriting Requirements?
Medicare Advantage Plans are offered by private insurance companies and they must follow certain rules set by Medicare.
One of these rules is that they cannot have underwriting requirements in order to qualify for a Medicare Advantage plan. This means that people with Medicare Advantage Plans can’t be denied coverage or charged more because of their health status.
This requirement is not limited to a specific open enrollment window and last forever similar to the Affordable Cares Act. As a trade-off, Medicare Advantage plan insurers take control of your medical decision power.
This means the insurance provider has the ability to implement rules such as requiring referrals, prior authorizations, step therapy, limiting network access, and making medical decisions on how they want to treat your medical condition.
Most healthy Medicare beneficiaries don’t mind this requirement until they become very ill.
Medicare Beneficiaries enrolled in Original Medicare with Medigap plan remain under freedoms of Original Medicare. They do not have limited networks, do not require a referral, or prior authorizations, step therapy is non-existent, and their doctor maintains control over their medical treatment plan.
Medigap policies have no control or say in the treating process and must pay all bills that are deemed medically necessary by Medicare.
How to Qualify for Medicare Supplement Plan Guaranteed Issue Rights: Avoid Medical Underwriting
Medigap Guaranteed issue rights protect you in certain situations allowing you to avoid underwriting questions.
Examples would include:
- Applying for a Medicare Supplement Plan During your 6-month initial Medigap Open Enrollment Period
- Leaving a Medicare Advantage Plan and returning to Original Medicare during your initial 12-month enrollment period
- Losing Medicare Advantage Plan
- Moving to a new state
There are other times when you might be able to buy a Medigap policy without answering health questions too. For example, some states have their own rules about guaranteed issue rights.
Which States allow for Additional Medigap Open Enrollment Periods
The following states allow for additional Medicare Supplement open enrollment periods.
- California- Birthday Rule
- Connecticut – Year-Round Open Enrollment
- Idaho – Birthday Rule
- Illinois – Birthday Rule
- Iowa – Birthday Rule
- Maine – Year-Round Open Enrollment
- Massachusetts – Year-Round Open Enrollment
- Missouri – Anniversary Rule
- New York – Year-Round Open Enrollment
- Nevada – Birthday Rule
- Oregon – Birthday Rule
- Vermont – Year-Round Open Enrollment
- Washington – Year-Round Open Enrollment
While these states are providing additional open enrollment periods for Medigap plans, these states have the most expensive plan options. The same Medicare Supplement plan in other states not providing this option can be hundreds of dollars less expensive per month.
The Birthday rule and anniversary rule are very similar to each other as they provide a short window to make a change either around your birthday month or the renewal month policy Medigap policy.
This window is typically a 30 to 60-day period of time allowing you to switch Medigap plans and not be subject to medical underwriting.
Sample Medicare Supplement Underwriting Eligibility Questions: Applying for Medigap
There are a number of questions that may be asked during the underwriting process related to your current and past health conditions. The specific questions will vary depending on the insurance company you are applying with.
Insurance company A may ask questions that will result in an instant denial, where Insurance company B the same question may not exist allowing you to qualify.
Here are some sample questions asked on a Medicare Supplement Application that could result in a denial or higher rates:
- Are you currently bedridden, hospitalized, in a nursing or assisted living facility, and require help with activities of daily living (ADL), receiving home healthcare, or using supplemental oxygen?
- In the past 24 months have you been admitted to a hospital, skilled nursing facility, or rehabilitation facility or advised to have surgery, treatment, or testing?
- Have you used any tobacco products of any form (including e-cigs) in the past 12 months?
- List any physicians you’ve seen in the past 24 months
- List all Medications you are currently taking or have taken in the past 36 months
As part of your application process, you will also be required to release all medical information being requested by the insurance company.
Many Medicare Beneficiaries decide to roll the dice and sign up for a Medicare Advantage Plan for the first few years they are Medicare eligible and believe they can simply move later in life. They do not realize that medical conditions happen fast and may prevent them from changing down the road.
Before you join a Medicare Advantage plan make sure you fully understand the health insurance coverage you are agreeing to sign up for. Talk with one of our Medicare Agents and discuss all available options prior to making your decision.
I have Minor Health Conditions will I pass the Medical Underwriting Process: Most Likely You will Obtain a Medigap Plan Approval
Minor health conditions are usually pre-existing conditions that have been well controlled with medication and do not require frequent doctor visits or hospitalizations.
Generally speaking, if you have minor health conditions that have been well controlled, you are likely to be approved for a Medigap policy.
While we cannot guarantee this will be the case for all conditions we believe are “minor” one of our Medicare Insurance Agents can discuss each medical condition and review what Medicare options are available.
Do you have any Pending Surgeries and Treatments: They may disqualify you for a Medigap Plan
If you are enrolling in a Medigap plan outside of your guaranteed enrollment period, you may be subject to medical underwriting to get a Medigap Plan N.
Pending surgeries and treatments can be disqualifying factors because they indicate that you have an existing medical condition that needs to be treated. Medigap plans are designed to cover unexpected medical expenses, not pre-existing conditions.
If you have a pending surgery or treatment, it’s likely that your condition will be considered pre-existing and you’ll be denied coverage or charged a higher monthly premium.
If you have any pending surgeries or treatments, it’s important to talk to your insurance company before applying for coverage. They’ll be able to tell you whether or not you’re likely to qualify based on their underwriting guidelines.
It is vital to buy a Medigap plan during your Medigap initial enrollment period, once your open enrollment period has passed you are no longer guaranteed to be accepted for a Medigap plan without medical underwriting.
Did you have any Recent Major Care: The Medicare Supplement Applications will Inquire
Recent major care refers to any significant medical treatment or procedure that you have received in the past two to five years. This can include things like cancer treatment, heart surgery, or a transplant.
Insurance companies will often take this into account when determining your rates, as it can be an indicator of future health risks.
How it affects your policy:
If you have had recent major care, it is likely that your insurance rates will be higher than someone who has not had any significant medical treatment.
However, this is not always the case, and it is important to work with an independent Medicare insurance agency like Integrity Now Insurance Brokers who can help shop around for the best rate possible.
Health Questions Related to Chronic, Incurable Health Conditions: Medicare Advantage Plan May be Your Only Option Outside of your Guaranteed Enrollment Period
Medicare Advantage is a type of health insurance that covers all of the benefits of Original Medicare (Parts A and B) plus additional benefits, such as prescription drug coverage. Some Medicare Advantage plans also offer extra perks, like dental and vision coverage.
The main benefit of enrolling in a Medicare Advantage plan is that they are required to accept all Medicare Beneficiaries no matter their existing medical conditions.
If a Medicare Beneficiary is attempting to buy a Medigap plan for the first time outside of their guaranteed rights period, they will be subject to medical underwriting. A chronic health condition could prevent them from being accepted for Medicare Supplement policies.
Automatically Decline Based on Underwriting Prescription Drug Lists
Medical underwriting can be a major problem for many older adults looking to buy a Medicare Supplemental plan pasted their initial enrollment period.
Insurance companies will not only review your health conditions but also your prescription medications. There are specific medications that will result in an automatic decline from the insurance company as it shows evidence of a major medical condition.
If you are automatically declined for Medigap coverage because of the drugs on your list, there are a few things you can do.
You can try to find a different Medigap plan that does not use the underwriting prescription drug list, or you can try to negotiate with the insurance company to prove the medication you are taking is not for a chronic medical condition.
Medical Records Review by Medicare Supplement Insurance Company
A medical records review is when a Medicare supplement insurance company requests your medical records from your doctor in order to determine if you are eligible for coverage.
The company will review your records to look for any pre-existing conditions that may not have been included in your application for coverage.
They may also want to review your records to see how serious a medical condition is that you listed on your medical records.
What companies request a medical records review:
Most Medicare supplement insurance companies will request a medical records review when you apply for coverage. However, some companies may not require a medical records review if you have had continuous creditable coverage (no lapse in coverage) for at least six months.
What is included in a medical records review:
A medical records review will typically include your doctor’s notes, laboratory test results, and hospital discharge summaries. The company may also request additional information such as X-rays or MRI reports.
What is the purpose of a medical records review:
The purpose of a medical records review is to determine if you have any pre-existing conditions that would make you ineligible for coverage under the policy. The company will also use the information to determine your premium rate.
What are the benefits of a medical reviews:
The benefits of having a complete and accurate picture of your health history helps ensure that you get the best possible rates on your policy. It also helps to avoid any surprises down the road if you need to make a claim.
Medicare Beneficiaries looking to change their Medigap policy may also need to have medical underwriting if are looking to increase coverage. If a Medicare Beneficiary is looking to switch to a plan of equal or lesser coverage they may not need to have medicare underwriting depending on the insurance company.
As a Medicare Beneficiary is it vital to know what’s in their medical records prior to applying for a Medigap plan. This can save you time and a lot of frustration.
Should You Submit a Medigap Application or Not?
If you are considering applying for a Medicare Supplement plan, we recommend talking with one of our licensed insurance representatives first.
We will ask you questions about the last time you went to the hospital, how often you visit a doctor each year, do you have any major medical conditions, what minor medical conditions you have, and what medications you are taking.
Once we have a clear picture of your medical history, we can help you make a better decision on which path is right for you.
Don’t Cancel Your Medicare Advantage Plan Until Your Medigap Eligibility is Confirmed
When trying to leave a Medicare Advantage plan and buy a Medigap plan it is critical to wait for approval and confirmation of the effective date of coverage. Until we have this information we do not recommend canceling your Medicare Advantage plan.
It is also important to mention to not sign up for a standalone Medicare Part D prescription drug plan until you have been approved for a Medigap plan. If you sign up for a standalone Part D plan you will automatically be disenrolled from your Medicare Advantage plan.
My Medicare Supplemental Application Was Denied: Medigap Open Enrollment Period Without Medicare Guaranteed Issue Rights
If your application for a Medigap policy is denied, you may have a few options. You can reapply for coverage with a different insurance company, look for a new Medicare Advantage plan, or appeal the decision.
What to do if you have a pre-existing condition:
If you have a pre-existing condition and are denied coverage, you may be able to get coverage through a Medicare Advantage plan. You can also check if a different insurance company will consider you for coverage.
It is critical to work with independent Medicare insurance brokers so they can review the situation and apply for all available options.
Why Does Federal law provide very Little Consumer Protection for Medigap Policies?
Although Medigap insurance is state regulated, it falls under certain federal minimum requirements and consumer protections. For example, Medicare Supplement plans are required to be standardized insurance plans by federal law to make comparisons of benefits and premiums simpler for customers.
According to federal law, Medigap insurers must offer “guaranteed issue” policies to Medicare Part B subscribers aged 65 and older for the first six months of their enrollment in the program and other qualifying events.
Medigap insurers may not refuse a policy to any applicant due to age, gender, or health status during their guaranteed issue rights. Furthermore, during these timeframes, Medigap insurance companies cannot vary premiums based on an applicant’s pre-existing medical conditions (i.e., medical underwriting).
Barriers for Medicare Beneficiaries with Disabilities who are Under Age 65
There are a number of barriers that Medicare beneficiaries with disabilities who are under the age of 65 faces. One of the biggest barriers is the lack of knowledge about what Medicare covers and how to sign up for it. Many people with disabilities are not aware that they may be eligible for Medicare coverage.
Another barrier is the cost of premiums and out-of-pocket costs. For many people with disabilities, these costs can be prohibitive. This is especially true if someone is on a fixed income or has high medical expenses.
Finally, another barrier that people with disabilities face is access to care. Many doctors and other healthcare providers may not accept Medicare patients on certain Medicare Advantage plans, which can make it difficult for people with disabilities to get the care they need.
What are the Types of Medigap plans?
Medicare Supplement plans are broken into ten different plans. Each plan offers different coverage based on what you can afford and need.
- Plan A: Offers the least amount of benefits and primarily provides hospitalization coverage.
- Plan B: This plan covers the core benefits plus some extra benefits.
- Plan C: This plan covers the core benefits plus some extra benefits, including foreign travel insurance.
- Plan D: This plan covers the core benefits plus some extra benefits, including hospice care.
- Plan F: This is the most comprehensive plan and covers all of the core and extra benefits.
- Plan G: This plan covers all of the core and extra benefits except for Part B deductible.
- Plan K: This plan covers 50% of the costs for covered services after you meet your annual out-of-pocket limit.
- Plan L: This plan pays 75% of covered services after you meet your annual out-of-pocket limit.
- Plan M: This plan pays 50% of covered services after you meet your Part A deductible.
- Plan N: This plan pays 100% of Part B coinsurance (except copayments)
How do Medigap Policies Work?
In order to be eligible for a Medigap plan, you must first be enrolled in Medicare Part A and Part B. Once you are enrolled in Medicare, you can then purchase a Medigap policy to help cover the costs of your deductibles, copayments, and coinsurance.
Medicare Beneficiaries chose a Medicare Supplement plan so they can keep the benefits they earned under Original Medicare.
Licensed insurance agents sell Medigap policies and review all available coverage in Medicare with their clients.
Certain states allow Medicare Beneficiaries to change their Medigap plan during certain times of the year without the need for medical underwriting.
What are the Benefits of Medigap Insurance Policies?
Medigap plans help pay some of the health care costs that Original Medicare doesn’t cover. This includes copayments, coinsurance, and deductibles.
Under the federal Medicare program, CMS requires all Medigap plans offered by private insurance companies to be standardized. This means a Medigap Plan G provides the exact same coverage no matter which insurance company is providing the secondary insurance coverage.
Current Medigap recipients can not be canceled by the insurance company for any future medical conditions that develop. Medicare Supplement plans are guaranteed renewable as long as you continue to pay your monthly insurance premium.
What is the 6 Month Medigap Open Enrollment Period: Why you must enroll in this period?
The 6 Month Medigap Open Enrollment Period is a special enrollment period that allows you to sign up for a Medigap policy without having to go through medical underwriting. This means that even if you have health problems, you can still get coverage.
The Open Enrollment Period lasts for six months and starts the month you turn 65 and are enrolled in Medicare Part B.
How to Compare Medigap Plans?
There are 10 standardized Medigap plans available in most states, each identified by a letter.
Plan A is the most basic, while Medicare Supplement Plan G and Plan N offer more comprehensive coverage. Plan F provides the most comprehensive health benefits however, it is no longer available to new Medicare-eligible beneficiaries effective January 1, 2020.
What to look for in a plan:
When considering a Medigap plan, it’s important to compare the benefits offered by each one.
Some things to keep in mind include:
- What kinds of medical expenses does the plan cover?
- Does the plan have any deductibles or copayments? If so, how much are they?
- Does the plan cover Part B excess charges?
- Is Medicare Part A deductible covered?
- Does the plan cover foreign travel emergency care?
- Are skilled nursing facility’s coinsurance costs covered?
How to Enroll in Medigap?
To be eligible for Medigap, you must first be enrolled in Medicare Part A and Part B.
The best time to enroll in a Medigap plan is during your six-month Medigap Open Enrollment Period, which starts the month you turn 65 and have Medicare Part B.
During this time, you can buy any Medigap policy sold in your state, even if you have health problems.
If you wait to enroll after your six-month window is up, you may not be able to get coverage or may have to pay more for a policy.
Work with a Medigap Insurance Expert and Win!
Integrity Now Insurance Brokers is a Medicare insurance expert and is here to help you from start to finish.
As your Medigap Insurance Expert, we will help you understand how Medicare Supplement plans work, compare different plan options, and enroll in the plan that’s right for you.
It is possible you may only qualify for a Medicare Advantage plan today. We will do our best to find the most comprehensive coverage in your local area. We will also let you know if and when in the future you may be able to re-apply for a Medigap policy.
No matter the type of plan you are needing help with we are here for you. Reach out to one of our Medicare insurance agents today at (562) 735-3553 or complete our online Medicare quote request form.