As an agent, Medicare Supplement underwriting can often be one of the most important (and frustrating) parts of this business.
Every insurance company has their own set of underwriting guidelines, look-back periods, and “gotcha” questions buried in their Medicare Supplement applications. And if you’re sitting across from a prospect who just had a heart attack three years ago or is on insulin for uncontrolled diabetes, you know how quickly a deal can get derailed if you don’t know the rules, or worse yet, can’t quickly find the information.
That’s where a solid cheat sheet comes in. Unfortunately it’s tough to find a universal one-size-fits-all guide, but I’ll share with you what has worked great for me.
So in this post, I’m going to give you a few things:
- How I approach navigating Medigap underwriting in the field.
- How to avoid landmines with common health conditions.
- And the tool I personally use that gives me answers in seconds, not hours. A tool that we’re happy to share with you.
For those of you new to selling supplements, we will start with some basics.
What Is Medicare Supplement Underwriting?
Medicare Supplement underwriting is the process carriers use to evaluate your client’s health history, medical records, and sometimes even their prescription drug use to decide if they’re eligible for a Medigap policy, and at what monthly premium they will be charged.
Outside of guaranteed issue rights such as turning 65, living in a birthday rule state, or a state that doesn’t have underwriting questions, your clients are answering health questions as part of the qualification process, and those answers will determine their acceptance or denial for a policy with any given insurance company.
So, do all Medicare plans involve underwriting?
No. But if your client isn’t in their initial enrollment period, is switching from a Medicare Advantage plan back to Original Medicare, or has missed their Part B effective window, underwriting is usually required to qualify for Medicare Supplement insurance. Check with your local state rules to verify based on where you are selling to determine eligibility.
What’s Included in a Medicare Supplement Underwriting Cheat Sheet?
A good cheat sheet gives you the underwriting guidelines for multiple carriers at a glance:
- Look-back periods for major events like cancer, COPD, kidney failure, or congestive heart failure
- Disqualifying meds and dosages
- Whether a client with rheumatoid arthritis, ALS, or multiple sclerosis is eligible
- Timeframes for heart attack or stroke recovery
- If Part A or Part B was delayed, and how that affects eligibility
But here’s the kicker, this stuff changes. Carriers tweak underwriting guides constantly, and by the time you print a cheat sheet, it’s probably already outdated. Below is a glimpse of what you’ll be able to see across all the available carriers.
What Disqualifies You from Medigap?
I sold life insurance for a long time and used one specific question for quickly assessing underwriting, and I use the same questions with prospects interested in a med supp. My approach was always around quickly identifying pre existing conditions to rule out major underwriting hurdles.
My question was simple, “can you tell me your height and weight and confirm if your have any pre existing conditions related to your heart, liver, lungs, kidney or brain?”. The answer to this question would give me a lot of intelligence for quickly assessing underwriting hurdles.
The top red flags that could result in a decline across most insurance companies include:
- Oxygen use
- Current cancer treatment
- Late-stage COPD
- Recent heart attack, stroke, or hospitalization
- Insulin-dependent diabetes paired with certain complications
- Kidney failure or dialysis
But again, these can and will vary by insurance company. That’s why relying on just memory or PDFs isn’t enough anymore.
The Tool That Replaced My Paper Cheat Sheet
This isn’t rocket science and unfortunately a lot of agents still do not know it exists.
Instead of guessing or flipping through dozens of underwriting guides, I use a tool that lets me:
- Input a ZIP code and choose the correct county.
- Choose a Medicare Supplement Plan G (or any other plan).
- Select health conditions like “heart attack in the last 2 years” or “rheumatoid arthritis”.
- And instantly compare carrier rules side-by-side.
Whether you’re dealing with a first-time buyer or someone shopping for a better rate, it helps make quick, confident recommendations that increase the chance of approval vs. decline.
Why Underwriting Impacts Medicare Supplement Pricing
How does the underwriting process affect Medicare Supplement premiums?
Clients with cleaner health histories often qualify for lower monthly premiums, while those with higher risk profiles may face:
- Policy decline
- Rated or Higher premiums
- Riders or policy exclusions
- Fewer carrier options in their service area
Your ability to navigate the underwriting process directly impacts your close rate and your client’s satisfaction with their health care coverage.
How to Avoid Medigap Underwriting Altogether
If you’re wondering, how to avoid Medigap underwriting?, here’s what to look for:
- Apply during the Open Enrollment Period (6 months surrounding your Part B effective date). This means if you’re Part B is effective June 1st, you can enroll 3 months before (March) and up to 3 months after (September).
- Leverage guaranteed issue rights (loss of employer coverage, plan termination, etc.) or new to Medicare.
- Move from Medicare Advantage back to Original Medicare during trial right periods.
Timing is everything. And this is where most beneficiaries get tripped up. They miss deadlines and end up facing stricter requirements when it could’ve been avoided.
Which Medicare Supplement Plan Is Most Popular?
There’s no universal winner, but Medigap Plan G continues to be the most popular for its balance of coverage and cost. It covers:
- Part A coinsurance and hospital costs
- Part B coinsurance and Medical costs
- Excess charges
- Foreign travel emergency care
However, pricing, eligibility, and underwriting differ by carrier and state. So comparing Medicare supplement policies side-by-side is a must, and tools like ours make that fast and easy.
What To Do Next?
Be honest with yourself, you’re not going to remember every underwriting question or whether a Medicare Supplement insurance carrier asks about medical history within 2 years or 5.
That’s why you need a smarter system than sticky notes, old PDFs, or guessing. It’s just too much and luckily, technology is becoming a better and better friend to us! Technology allows you to quickly compare Medicare supplement premiums by carrier as well as the related information for pre-existing health conditions.
Contract with SMA and get full access to our Med Supp comparison and underwriting tool at no cost.
