While Medicare Advantage (Part C) plans never require medical underwriting, understanding underwriting and guaranteed issue rights is key for anyone considering a Medicare Supplement Insurance plan (MediGap). By learning how these processes work and how underwriting requirements differ across states, individuals can make more informed decisions about their healthcare coverage options.

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What is Underwriting?

Underwriting is a process used by insurance companies to evaluate an individual’s health status, medical history, and other risk factors before issuing a MediGap policy. If a beneficiary is being underwritten, it helps insurance companies assess the likelihood of future claims, and thereby determine if the individual would be accepted into the plan or if any premiums adjustments would need to be made to offer coverage.

It’s important to note that there is NO underwriting for your initial enrollment into Medicare; this is when you turn 65, or leave your employer-provided credible coverage after the age of 65.

Why Do I Have to Go Through Underwriting to Get a Medicare Supplement Insurance Plan?
Underwriting is necessary for Medicare Supplement Insurance plans to ensure that individuals are eligible for coverage and to determine the cost of their policies. By assessing an applicant’s health status and medical history, insurers can better manage risk and maintain financial stability. Underwriting also helps prevent adverse selection, where individuals with higher healthcare needs are more likely to purchase coverage, leading to higher costs for everyone.

What is Guaranteed Issue?

Medigap guaranteed issue is a consumer protection where you can’t be turned down for a policy or be charged more than others in your age group. Guaranteed issue rights virtually allow individuals to enroll in a Medicare Supplement Insurance plan without undergoing underwriting during certain situations, such as when they are first eligible for Medicare or when they experience a qualifying event.

Which states have NO underwriting for Medicare Supplement Insurance plans?

Connecticut, Massachusetts, Maine, and New York are the 4 states that have no underwriting requirements for Medicare Supplement Insurance plans. In these states, individuals have guaranteed issue rights all year long, which means they will never undergo medical underwriting if they are able to apply for Medicare Supplement coverage. This ensures they cannot be denied coverage or charged higher premiums based on their health status upon enrolling in a new Medigap plan.

What if I live outside of Connecticut, Massachusetts, Maine, or New York?

In some other states, including California, Louisiana, Idaho, Illinois, Nevada, Oregon, and Maryland, specific rules grant Medicare-Supplement beneficiaries guaranteed issue rights during the month of their birthday. This means that enrollees are allowed to select any Medigap plan available in their area WITHOUT going through medical underwriting during a 30-day window following their birthday each year. It’s important to check in with your Medicare broker or a reliable Medicare-expert to confirm the terms & conditions for underwriting in your home state.