Medicare Supplements & Medical Underwriting

The practice of Medical underwriting is used by private health insurers to determine if they are insuring a potential beneficiary. This is a health insurance term that refers to the use of medical or health information when evaluating an applicant for insurance coverage, usually for life or health insurance. As part of the underwriting process, a person’s health information can be used for two decisions: offer or reject coverage and establish the premium rate of the policy.

During the process of underwriting, the applicant may be required to submit to a physical examination and the insurer may reject the person based on the results or the patient’s history.

If you enroll in a 2019 Medicare supplemental policy (also known as Medigap) within your open enrollment period, you have “guaranteed issue right” enrolling you for a Medigap plan that is offered within your area of coverage.

During this open enrollment, insurance companies cannot refuse or charge a higher premium based on an existing disability or health condition. Insurers cannot require you to submit to health insurance.

Your Medicare supplement open enrollment period persists for 6 months. And it commence on the very 1st day of any month that you become 65 years old and signed up for Medicare Part B. The period cannot be delayed and, when it ends, you will not be able to gain it back. If you decide to defer coverage for Medicare Part B, Medigap will not begin to open your record unless you have Medicare Part B.

If after the open enrollment period you choose to enroll for a Medigap Plan, you might not possess a guaranteed issue. You might need to go through the medical underwriting process. Any insurer can review your medical history and may refuse to sell you a plan or may sell you a policy at a higher price if you do not comply with the terms of the policy.

There are exceptions whereby beneficiaries can enroll in a supplementary Medicare plan with guaranteed issue outside of their open enrollment. These include:

You will be involuntarily disenrolled from the plan if you enrolled for a Medicare Advantage plan and you are moving out of the plan’s coverage area. In this case, you will also qualify for a special election period to enroll in another Medicare Advantage policy. You must enroll in a new Medicare Advantage plan with a validity date that begins the month just after your shift or at the start of the 7th month. Else, you will be enrolled automatically in Original Medicare. You may have a guaranteed right if you return to Original Medicare.

  • If you have coverage under an employer health plan and Original Medicare and your employer’s health insurance is winding up.
  • If your Medicare Advantage plan leaves Medicare and you go back to Original Medicare.
  • If you leave Medigap or Medicare Advantage plan because the insurance company cheated you or did not obey the law.
  • If your Medigap insurance firm becomes bankrupt or loses coverage without your own fault.