Medigap Medical Underwriting: What It Is and When It Applies

Medical underwriting is the process an insurance company may use to look at your health before it offers a Medigap policy. You may be asked health questions on an application. The company may also review other records. Based on what it learns, it may accept you, decline you, or offer coverage on different terms.

Whether underwriting applies depends on timing. Many people have a Medigap open enrollment period when they first have Medicare Part B, during which companies generally cannot use health history to decide. Guaranteed issue rights are special situations that may also protect you from underwriting. The details vary by state and change over time.

Medigap plans are standardized by letter. Only Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible for Medicare. Plans C and F (and high-deductible F) are available only to people who became eligible before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today. Massachusetts, Minnesota and Wisconsin standardize Medigap differently.

Traditionally, people try to join a Medigap plan during their open enrollment period, because that is when medical underwriting generally does not apply. Many people mark that window on the calendar when they are getting ready to turn 65 or start Part B.

People who already have a Medigap plan or a Medicare Advantage plan sometimes consider changing later. Outside open enrollment or a guaranteed issue situation, a company may be allowed to ask health questions in many cases. Some people stay with what they have. Others apply and see what a company decides.

Some states have extra rules, such as annual windows tied to a birthday or policy anniversary, or access for people under 65. These differ widely. Official information is available at Medicare.gov, and your State Health Insurance Assistance Program (SHIP) offers free local counseling.

A Medigap agent may help you figure out whether underwriting is likely to apply to your situation. That often starts with a few questions about when you enrolled in Part B, what coverage you have now, and where you live. An agent may also explain whether any guaranteed issue right could apply.

A conversation is generally a chance to ask questions, not to commit. You might ask: Will this plan ask me health questions? What happens if I am declined? Are there state rules that give me more time? Which companies sell in my area? A licensed agent may be able to compare options from several carriers.

An agent may also help you think through Medigap alongside Medicare Advantage. Medigap offers the ability to see any provider nationwide that accepts Medicare, no networks or referrals, and predictable cost-sharing. Trade-offs include generally higher monthly premiums, possible underwriting outside certain windows, a separate Part D plan for drugs, and no routine dental, vision or hearing. Medicare Advantage often has lower premiums, an annual out-of-pocket maximum, extra benefits and drug coverage in many plans, but it may bring networks, prior authorization and copays. Call 1-800-MEDIGAP for more information.