Medigap Underwriting Questions: What Insurers Ask and When They Cannot

Each insurer writes its own application, so the exact wording differs. The flow, though, tends to look alike from one company to the next.

The table below groups the topics that commonly appear. It describes general categories only; the conditions, look-back periods and wording on any one form are set by that insurer and may differ.

General categories drawn from typical Medigap applications. Look-back periods (for example, two or five years) vary by insurer and by question.

A decline from one insurer does not bind another. Companies weigh the same condition differently, so a diagnosis that ends one application may be acceptable on another, depending on how long ago it happened and how it is treated now.

Federal law creates several windows in which an insurer must sell you a policy without using your health to deny you or raise the price.

From Medicare.gov. Which plans a guaranteed issue right lets you buy depends on the situation; see our guaranteed issue guide.

States can give more protection than federal law. A few remove health screening entirely; a longer list lets current Medigap holders switch once a year around a date such as a birthday.

Summaries only; rules change. Confirm the current rule with your state insurance department or State Health Insurance Assistance Program (SHIP). Example: our Oregon birthday rule page.

If you are near the end of a protected window, apply inside it even if you are unsure which insurer to pick. Once the window closes, the same application goes through full screening. Our page on Medigap and pre-existing conditions covers what insurers can do once you are approved.

Even when you are approved, an insurer may be allowed to delay coverage of a pre-existing condition for up to six months. Federal rules reduce that wait by one month for each month of prior creditable coverage, as long as the gap between coverages is no more than 63 days. Applying that rule gives the table below.

Our calculation from the federal rule described on Medicare.gov: maximum wait = 6 months minus months of creditable coverage, never below zero. Insurers can choose a shorter wait or none.

During Medigap open enrollment, the waiting period can still apply if you had less than six months of creditable coverage, but the insurer cannot refuse you. Outside protected windows, screening and the waiting period can both apply.