Medicare Supplement Underwriting Eligibility Questions – MedicareFAQ

questions about medicare supplements subscription are not always required. Sometimes, like during your open enrollment period, you receive a waiver of the health question requirements. If you’re changing a Medigap plan or lose your OEP, enrollment may be required.

We are going to delve into the information about the situations that usually lead to approval. then we can talk about when you may run into obstacles when changing plans. This information helps you understand if you are eligible for Medigap.

Reading: “””in states where medicare supplement insurance underwriting criteria

guaranteed issue means no health questions

Each beneficiary has a medigap open enrollment period when they turn 65 and first activate their part b. After researching Medigap, she will learn that the 6-month enrollment window allows her to request a supplement without a subscription. alternative situations are allowing a policy without subscription; These are collateral emission rights.

state medigap birthday rule

Five states have birthday rules, which allow beneficiaries to change their medigap policy around the month of their birthday without requiring the underwriting process. the beneficiary must already have a supplemental policy that is currently active to qualify. talk to your agent; they can get quotes to see if there is a lower rate.

If you find a good deal, the application process is quick and easy, especially when there are no medical underwriting questions.

washington allows eligibility for supplements throughout the year; this means that anyone could apply at any time and receive coverage. this also means that the rates in washington for supplements are much higher.

Understanding Medicare Supplement Underwriting Questions

You are now an expert in guaranteed trouble situations! what you need to know is how underwriting is done through carriers.

Each company has a minimum of one health-related questions form included in your medigap application.

some of the questions ask if you’ve ever had a particular condition; however, others ask for a more recent time. commonly, questions about the last two years of health history.

It is recommended that you answer no to some or all of the medical questions specified in the applications.

If you answer yes to a query, it can result in an instant rejection for most operators. this means you are not qualified for any coverage and do not need to apply.

Depending on state laws and carrier-specific exceptions, it’s best to talk to one of our experts about the possibilities.

In the next few sections, I’ll cover some sample questions that exist in companion apps.

small health problems can lead to approval

When you are fully healed and finish treatment, specific injuries will not be a problem. You’ll also notice that companies don’t care if you’ve caught the flu twice this year or if you have seasonal allergies.

Cholesterol and high blood pressure are unlikely problems when they do not occur with a later or more serious problem.

for example, mild arthritis is not a problem, but more severe rheumatoid arthritis could indicate a decrease in coverage.

Body mass index is not as strict in supplemental plans as it is in life insurance. having those few extra pounds is not a problem if you are not morbidly obese.

every company has underwriting guidelines and your broker will have company guidelines; This way, you won’t waste time applying when you get a denial.

Finish upcoming treatments and pending surgeries first

there are denial situations and the next procedures are at the top of the list. no company wants to cover you before an expensive test or surgery.

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Providers insist that you receive your covered treatments from your previous provider before applying for new coverage.

Even if your next surgery is not life-threatening, you will have to wait to apply. it is best to complete your surgery and all follow-up appointments or any required therapy. once it is complete, request the new provider.

Sample question from one of our operator’s applications:

“In the last 12 months, have you been recommended to have any treatment, diagnostic tests, further evaluation, or surgery that you did not have?”

Some providers ask about a specific time period after surgery, such as a knee replacement. Since there may be problems, they may ask you to delay the process for a year or more before applying.

These types of requirements vary, and it’s best to ask one of our experts which carriers give you the best opportunity.

please wait if you had recent important services

If you were hospitalized or received home health services two more times in the last two years, the company may deny you during the application. if you live in a nursing home, you will most likely not be eligible.

People rarely go from a nursing home or assisted living facility to living independently. you may need to keep your coverage indefinitely.

sample question from a carrier:

“Are you hospitalized, in a nursing or assisted living facility, confined to a bed, receiving home health care or any type of physical therapy?”

Cancer is a common concern among applicants. most companies want to see at least two years of successful, cancer-free remission before considering covering it. If you’ve had recent surgery or are undergoing any treatment, you’ll want to wait a couple of years before applying.

keep your coverage if you have a chronic incurable condition

There are many health problems that can be treated, but are still considered incurable diseases. When you have a disease that requires treatment forever, you’ll find that there are questions on many Medicare supplement applications that may exclude you.

several common examples include:

  • chronic lung problems
  • dementia
  • immunodeficiency disorders such as ms, rs, aids or lupus.
  • nervous system problems, such as Parkinson’s
  • If you have osteoporosis and fractures, this could be problematic. Insurance companies know that conditions like this will require lifetime costs of care.

    Heart disorders like this could cause a decrease:

    • heart attack
    • stents
    • strokes
    • arterial and vascular diseases
    • pacemaker
    • congestive heart failure
    • For valve problems and rhythm defects, most providers will decline coverage. under most circumstances, organ transplants and kidney failure may indicate a decline.

      medicare supplements subscription questions for borderline conditions

      How an insurance company phrases these queries in your specific application will determine whether they can successfully approve your supplement underwriting.

      An example of a common borderline condition would be diabetes and mental health.

      If you only take the oral medication or take less than 50 units of insulin, you must be approved. when you have diabetes, carriers look for additional conditions.

      So if you have high blood pressure and diabetes with high cholesterol or diabetic neuropathy, then it’s more difficult to get approved for coverage.

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      If you only have diabetes and no related conditions, you should be able to switch carriers.

      sample question:

      “Do you have diabetes with high blood pressure and need three or more high blood pressure medications to keep it under control? Does your diabetes require more than 50 units of insulin per day to control?

      mental conditions can also be a good example. Usually, if you see a therapist and take a simple antidepressant, that’s not a problem when you have a more serious mental disorder that can cause decline.

      sample question:

      “have you received treatment now or in the last two years for (including surgery), or been advised by a health care professional to receive treatment for major depression, schizophrenia, paranoid disorder, or bipolar disorder?”

      rejected for medication

      Prescription history records are available to medigap providers. In your request, you will want to allow the new provider to get your prescription records.

      You should be truthful and try to remember any recently prescribed medications.

      automatic medication refusal

      Of course, medigap providers have a list of drugs that indicate automatic denial. These medications are those that treat chronic or significant illnesses.

      If you take these drugs, you are indicating that you have a condition that could be expensive to cover. pain medications can be a problem if used for a long time.

      If you take a small round of a declinable drug after surgery, the company won’t consider it a problem. if you have been using it for years then that could be a potential problem.

      medical records

      Most people don’t know what’s in their medical records. think carefully; if a doctor tells you that he is pre-diabetic, he should ask what you are submitting to his file. Was the doctor sugar-coating the health condition during the conversation with you?

      Telling you that you are prediabetic is less significant, what exists in your file is the key. if your health chart says diabetes, that is what the carrier will incorporate into the assessment.

      submitting a medicare supplemental application with underwriting questions

      In the past five years, have you been diagnosed with, treated for, or taken any prescription medication for:

      • cancer
      • heart attack or any heart problem, such as a pacemaker or defibrillator
      • hit or aunt
      • afib (atrial fibrillation)
      • cop
      • diabetes
      • disabling arthritis
      • stenting
      • prescribed any anticoagulant medication
      • pending surgery
      • Even if you answer yes, this helps our brokers find the most compatible plan and carrier for your needs. Talking to an expert can simplify applying for coverage.

        Identifying the best company for you is simple, and applying is so easy it can be done over the phone.

        Supplement change is timely, so request an effective date within 2-3 weeks. this will give the underwriting department time to complete your request.

        must wait for a subscriber to call you; The telephone interview is a vital part of the carrier’s decision process.

        declinable conditions when requesting medigap?

        If you have any of the following health conditions, your application may be denied. although speaking to an agent can help clear the air.

        These conditions are usually an automatic rejection:

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        • als
        • alcohol/drug abuse
        • alzheimer’s disease
        • asthma (with three or more medications)
        • dementia
        • chronic bronchitis
        • cop
        • cystic fibrosis
        • cirrhosis
        • congestive heart failure
        • diabetes
        • emphysema
        • end stage renal disease (esrd)
        • fibromyalgia
        • heart disease
        • hepatitis
        • hiv/aids
        • immune disorders
        • multiple sclerosis
        • lupus
        • kidney disease requiring dialysis
        • mental/nervous disorder
        • myasthenia gravis
        • organ transplant
        • osteoporosis
        • hit
        • advised to undergo surgery/treatment
        • implantable cardiac defibrillator
        • use of supplemental oxygen
        • use of nebulizer