What is medical underwriting?
Medical underwriting happens when an insurance carrier considers an applicant’s medical history when determining whether the person is eligible for coverage, and if so, how much their premium will be.
It doesn’t apply to most parts of Medicare, which are guaranteed-issue — meaning the person’s medical history is not used to determine their eligibility, benefits, or premiums. This is true for Medicare Parts A and B, Medicare Advantage, and Medicare Part D.
But medical underwriting is used in most states when people enroll in Medigap plans outside of their six-month initial enrollment period or the limited special enrollment periods that are available.
Even during the initial enrollment period, medical underwriting is used by Medigap insurers to determine whether the policy will have a pre-existing condition waiting period of up to six months. But when an application is submitted during the initial enrollment period, the insurer must shorten the pre-existing condition waiting period by one month for each month of continuous prior coverage the person had.
So if a person applies for Medigap during their initial enrollment period and they had been uninsured for the previous six months, the insurer can impose a waiting period of up to six months before the person’s pre-existing conditions are covered. But if the person had continuous prior coverage before transitioning to Medicare, there will not be a waiting period before their pre-existing conditions are covered by their new Medigap policy.
