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Medical Underwriting

Medigap | Medical Underwriting – Health Questions

Navigating Medigap Outside of Enrollment Windows

During your Medigap Open Enrollment Period (OEP) or guaranteed issue periods, getting coverage is straightforward ─ no medical questions asked. Outside of these times, the process involves what’s called underwriting.

Medical Underwriting Questions

The good news? No need to undergo a physical examination. But before you get too comfortable, you’ll need to complete a medical questionnaire.

So, what kind of questions might you encounter? Each insurance company has its own unique Medigap application, and that means different health questions. Here’s a glimpse into what you might encounter:

  • Have you been recommended or scheduled for any non-routine testing, treatment, follow-up, or surgery that’s not yet done?
  • In the past 24 months, have you been hospitalized or visited the emergency room two or more times?
  • List your prescriptions for the last 18 months and why you were taking them.

The Not-So-Fun Stuff ─ Watch Out for Declinable Situations

Among common reasons for applications getting declined, diabetes tops the list, along with heart disease, stroke, or cancer.

If you have pending medical procedures, you may consider completing those before applying for Medigap. Insurers prefer not to issue coverage right before you undergo a costly test or surgery, even for minor procedures.

Some might even ask for a bit of time post-major surgery, like a year or two, before considering your application. This caution is also true for major health events like cancer ─ some insurers want a waiting period to ensure you’re in the clear.

If you’ve been receiving home health care, visited the emergency room a couple of times, or reside in assisted living or a nursing home, approval might be trickier.

Medical Information Bureau (MIB) Records

Being honest and upfront about your medical history is vital – it makes the process smoother. Remember, Medigap carriers can check something like your health “credit report” with the Medical Information Bureau (MIB). It’s a record of your medical and prescription history. The carriers have lists of medications that might lead to automatic declines, usually those treating significant or chronic illnesses. Taking one of these medications may indicate a potentially costly health condition for the carrier to cover. You need to know they can quickly spot red flags.

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