What Is Medical Underwriting for Medigap? How Insurers Decide

Underwriting produces one of three results: approval, approval at a higher rate class, or a decline.

Insurers check application answers against prescription and insurance industry databases.

Federal law bars the use of genetic test results and family genetic history.

Once a policy is issued, a later diagnosis cannot raise your premium or cancel coverage.

Approved

Issued at the standard or preferred rate class you were quoted

Approved, rated

Issued at a higher standard or substandard class where the insurer and state allow tiered pricing

Declined

Insurer will not issue the policy; you keep any coverage you already have

Conditions that often lead to a decline

Conditions often accepted when controlled

The Genetic Information Nondiscrimination Act of 2008 bars Medigap insurers from using genetic information to deny coverage or set rates.

The same law bars them from requesting or requiring a genetic test, and family medical history counts as genetic information.

Insurers cannot underwrite at all during your Medigap open enrollment period or a federal guaranteed issue window.

After a policy is issued, a new diagnosis cannot be used to raise your premium or cancel your coverage while you keep paying.

Request your own records Ask MIB for your free consumer file and review the prescriptions on file at your pharmacy so nothing surprises you.

List dates, not just conditions Write down when each diagnosis, surgery and new medication occurred, since look-back periods are measured in months and years.

Answer exactly what is asked Misstating health history can lead an insurer to rescind the policy later, which leaves you uninsured when you need it.

Keep current coverage in place Do not drop an existing policy or plan until the new one is approved in writing.

Check your timing first If a protected window is near, waiting a few weeks can remove underwriting entirely.