Medigap Underwriting Questions Guide: What Carriers Ask and Why
Medigap Underwriting Questions Guide: What Carriers Ask and Why
When you apply for Medigap outside your Open Enrollment Period, insurers use medical underwriting to evaluate your application. This guide explains what questions to expect and how to improve approval chances.
⚡ Quick Answer
Medigap underwriting reviews your health questionnaire, prescription drug history, Medical Information Bureau (MIB) report, and possibly your doctor's records. Common denial conditions include: recent heart attack/stroke/cancer (past 6-12 months), COPD with oxygen use, diabetes with complications, recent hospitalization, or expensive medications. Underwriting is NOT required during your 6-month Open Enrollment Period or in guaranteed issue situations. Best strategy: Apply during Open Enrollment for guaranteed approval. If applying later, be honest, apply to multiple insurers (underwriting varies), and consider less comprehensive plans (N, K, L) which may be easier to qualify for.
đź“Ś Key Takeaways
- Open Enrollment = No underwriting: Guaranteed approval for 6 months after Part B starts—always apply during this window
- Recent serious conditions cause denials: Heart attack, stroke, cancer in past 6-12 months; COPD with oxygen; diabetes with complications
- Underwriting varies by insurer: Apply to 3-5 insurers simultaneously—one may approve where another declines
- Be 100% honest: Lying or omitting conditions = policy rescission (retroactive cancellation)
- Less comprehensive plans are easier: Plans N, K, L may approve when Plan G declines due to lower insurer risk
Detailed Guidance
When Underwriting Applies
NO Underwriting Required:
- During Medigap Open Enrollment (6 months after Part B starts)
- During guaranteed issue situations (losing coverage, moving, etc.)
- In states with year-round guaranteed issue (CT, MA, ME, NY, VT)
Underwriting IS Required:
- Any other time you apply for Medigap
- Switching plans without guaranteed issue rights
- Applying for additional coverage
Common Underwriting Questions
Health History Questions:
| Question Category | Examples |
|---|---|
| Heart conditions | Heart attack, angina, bypass, stent, pacemaker |
| Cancer | Diagnosis, treatment, remission status |
| Respiratory | COPD, emphysema, oxygen use |
| Diabetes | Type 1 or 2, medications, complications |
| Stroke/TIA | Date, severity, lasting effects |
| Mobility | Use of wheelchair, walker, assistance |
| Hospitalizations | Past 12-24 months, reasons |
| Surgeries | Past 2-5 years, planned procedures |
| Medications | Expensive or specialty drugs |
Lifestyle Questions:
- Tobacco use (past 12 months)
- Height and weight (BMI calculation)
- Alcohol use (some insurers)
The Underwriting Process
Step 1: Application Questionnaire
- Complete health history form
- Answer yes/no to condition list
- Provide details for “yes” answers
- Sign authorization for records release
Step 2: Records Check
- Insurer checks prescription drug database
- Requests Medical Information Bureau report
- May request medical records from doctors
- May ask for attending physician statement
Step 3: Underwriting Decision
- Approval as applied
- Approval with rating (higher premium)
- Approval with exclusion waiver
- Decline (denial)
Timeline: 2-6 weeks typically
Conditions That Often Lead to Decline
Recent or Serious Conditions:
| Condition | Typical Underwriting Response |
|---|---|
| Heart attack (past 6 months) | Decline |
| Heart attack (6-24 months ago) | Possible rating/exclusion |
| Stroke (past 12 months) | Decline |
| Cancer (active treatment) | Decline |
| Cancer (in remission <2 years) | Possible rating/exclusion |
| COPD with oxygen use | Decline |
| Diabetes with complications | Decline or rating |
| Recent hospitalization | Decline or postpone |
| Planned surgery | Postpone until after surgery |
Less Serious Conditions:
- Controlled high blood pressure: Usually approved
- Controlled cholesterol: Usually approved
- Arthritis: Usually approved
- Remote cancer (>5 years remission): Often approved
- Remote heart attack (>5 years): Often approved
Tips for Better Approval Chances
1. Apply During Open Enrollment
- No health questions asked
- Guaranteed approval
- This is always the best strategy
2. Apply When Healthy
- Don’t wait until health declines
- Apply before major surgeries if possible
- Lock in coverage while insurable
3. Be Honest and Complete
- Lying = insurance fraud = policy rescission
- Omissions = grounds for denial
- Honesty about minor conditions usually okay
4. Apply to Multiple Insurers
- Underwriting varies by company
- One may approve where another declines
- Apply to 3-5 insurers simultaneously
5. Consider a Less Comprehensive Plan
- Plans with higher copays (Plan N, K, L) may be easier to qualify for
- Insurers view them as lower risk
- Switch to comprehensive plan later if health allows
6. Work with an Independent Agent
- Experienced agents know which insurers are lenient
- They can guide you to the best options
- They know which questions matter most
The Medical Information Bureau (MIB)
What Is MIB?
- Database of previous insurance applications
- Records conditions disclosed on past applications
- Helps insurers detect fraud and omissions
What MIB Reports Contain:
- Conditions you disclosed on previous applications
- Dates of previous applications
- Declines from other insurers
MIB Report Accuracy:
- You can request your free MIB report annually
- Correct errors before applying
- Inconsistencies can lead to decline
State-Specific Underwriting Protections
States with Additional Protections:
- California: Certain conditions cannot be considered
- New York: Community rating limits health-based pricing
- Some states limit look-back periods
States with NO Additional Protections:
- Most states allow full medical underwriting outside Open Enrollment
See our Medigap Guaranteed Issue Rights by State for details.
Underwriting Preparation Checklist
- Determine if you have guaranteed issue rights
- If no: Request your MIB report and correct errors
- List all medical conditions and medications
- Gather dates of diagnoses, surgeries, hospitalizations
- Be prepared to explain any health issues
- Apply to multiple insurers simultaneously
- Consider less comprehensive plans if health is poor
- Work with experienced independent agent
- Be 100% honest on all applications
- Use our calculator to compare plans
Frequently Asked Questions
Do I need a medical exam for Medigap underwriting?
No. Medigap underwriting is questionnaire-based. No physical exam, blood tests, or paramedical exam are required. However, insurers may request medical records.
How far back do underwriting questions go?
Most ask about conditions in the past 2-5 years. Some conditions (cancer, heart disease) may have longer look-back periods. Always be honest about your full history.
Can an insurer require a doctor’s statement?
Yes, insurers can request an attending physician statement (APS) from your doctor. This provides details about your condition and prognosis. This can slow the application process.
What if I forgot to list a condition?
If discovered, the insurer can rescind your policy (cancel it retroactively). Always review your application carefully before submitting. When in doubt, disclose it.
Does underwriting affect my premium?
If approved, you’ll pay the standard premium for your age. Some insurers may offer coverage with a “rated” premium (higher than standard) for certain health conditions.
Can I be denied Medigap coverage entirely?
Yes. Outside Open Enrollment or guaranteed issue situations, insurers can deny coverage based on health history. If denied, try other insurers (underwriting varies), consider less comprehensive plans, or wait for a guaranteed issue opportunity.
What is the Medical Information Bureau (MIB) report?
The MIB is a database of your previous insurance applications. It records conditions you disclosed when applying for life, health, or disability insurance. Insurers check MIB to detect fraud and inconsistencies. You can request a free copy annually to verify accuracy.
How long does underwriting take?
Typically 2-6 weeks. Delays occur if the insurer requests medical records or an attending physician statement. Apply well before you need coverage to begin.
Can I switch Medigap plans without underwriting?
Only during Open Enrollment or with guaranteed issue rights. Otherwise, switching plans requires medical underwriting and can result in denial. Some states have annual switching windows (California birthday rule) that bypass underwriting.
What conditions typically get approved without issues?
Controlled high blood pressure, controlled cholesterol, arthritis, remote cancer (>5 years remission), and remote heart attack (>5 years) are usually approved. Minor conditions rarely cause problems if well-managed.
Should I use an independent agent for underwriting?
Yes. Experienced independent agents know which insurers are lenient, which conditions cause problems, and how to present your application favorably. They can guide you to insurers most likely to approve your specific situation.