Medicare Supplement Underwriting Questions - An Overview

In this article...
  • Medicare recipients are sometimes required to answer underwriting questions when applying for supplemental benefits. Find out more about these requirements.

Medicare supplement underwriting questions are questions on Medigap applications that insurance agents may utilize to determine eligibility and policy costs. However, underwriting questions are generally only allowable outside of Medicare and Medigap open enrollment periods. 

Are Medicare Supplement Underwriting Questions Required for All Applicants?

Medicare supplement underwriting questions aren't usually a mandatory requirement during Medicare's open enrollment periods. Outside the open enrollment time frame, applicants may be required to answer certain eligibility questions pertaining to current and past health conditions.

What Are Medicare Guaranteed Issue Rights?

Medicare guaranteed issue rights protect Medicare applicants from preexisting illness discrimination. During the open enrollment period for Medigap, each beneficiary is provided a 6-month waiver period in which they're allowed to apply for supplemental plans without answering underwriting questions.

Additional scenarios in which recipients can utilize Medicare guaranteed issue rights include employer plans that support Medicare ends, Medigap insurance companies filing for bankruptcy, instances where Medicare recipients were misled by Medicare companies and situations that require recipients to move out of Medicare SELECT plan service areas. 

Medicare guaranteed issue rights are also referred to as Medigap protections. Essentially, these rights ensure that beneficiaries are protected from unfair medical underwriting. Under these protections, insurance companies are prohibited from denying coverage or charging excess fees for Medigap policies to individuals with pre-existing conditions. When the time comes to enroll in a Medigap plan or renew their existing policies, recipients should consult with their plan advisors to determine whether they're eligible for Medicare guaranteed issue rights. 

What Are Some Examples of Medicare Supplement Underwriting Eligibility Questions? 

Some examples of common Medicare supplement underwriting eligibility questions include: 

  • In the last 5 years, have you been diagnosed with or received medical treatment for cancer, stent placement, diabetes, COPD, stroke or heart attack?
  • Are you currently taking or have you been prescribed blood thinning medications in the past 5 years?
  • Within the last 2 years have you been diagnosed with or received treatment for severe depression, schizophrenia or bipolar disorder? 
  • Are you scheduled for a pending surgical procedure?
  • Do you have a history of alcoholism?

What Are Some Reasons for Medigap Plan Denial? 

For individuals applying for Medigap plans outside the open enrollment periods, policies can be denied for a wide range of medical reasons. Some medical conditions that may result in automatic coverage declines include: 

  • Alcoholism
  • Chronic bronchitis
  • Congestive heart failure
  • End-stage renal disease
  • Heart disease
  • Immune disorders
  • Lupus
  • Mental or nervous disorders

Specifics for Medigap denial criteria can vary from state to state, so it's always best for applicants to consult with an insurance professional to verify specific state policy rules and regulations. It's also important to note that answering yes to certain eligibility questions may result in automatic Medigap policy denial.

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