UNDERSTANDING MEDICARE SUPPLEMENT UNDERWRITING

Michael T. Braden May 7, 2026 Medicare 101

Photo of Braden Medicare Insurances' Medicare Supplement Underwriting Poster

MEDICARE SUPPLEMENT UNDERWRITING GUIDELINES

·        If you can truthfully answer ‘No’ to all or most of the underwriting questions you encounter on a Medicare Supplement application, you should have a good chance of passing the underwriting process, depending on the carrier, as some carriers have more stringent rules than others do.

·        Chronic conditions like immune disorders, having been diagnosed or prescribed COPD medications or medications usually used in the treatment of Congestive Heart Failure, Atrial Fibrillation, having an implanted Defibrillator, and other major heart disorders often result in your new Medicare Supplement Application being denied.  Some carriers can decline you if you use Insulin to control Diabetes.  However, minor conditions like Asthma or Hypertension are usually not an issue.

·        Some states have special underwriting rules that offer additional enrollment periods for residents to apply for Medigap plans without underwriting, including California, Illinois, New York, Washington, Maryland, Kentucky, Idaho, Oregon, Utah, Virginia, and New Mexico. There are currently 21 States that have some form of Birthday or Anniversary Rules for Medicare Supplement Enrollments.

Most of the time, after your initial Enrollment for a Medicare Supplement or Medigap plan, Medical Underwriting is usually required when you want to switch carriers or change to a different “lettered” Medicare Supplement plan.

Perhaps you’ve been on your Medigap plan for a while, and the rate has gone up a few times. Maybe you originally signed up for Plan F, and now you are interested in switching to Medicare Supplement Plan G, which has lower monthly premiums and historically lower premium increases than your current Plan F.

One of the most important decisions one can make once they turn 65 is their one chance to enroll in any Medicare Supplement plan of their choosing with Guaranteed Issue Rights, and they do not have to answer any Medical Questions.  However, once that Initial Enrollment Period or Medicare Supplement Open Enrollment Period has passed, there is no guarantee you will be approved for a Medicare Supplement plan in most states.

You’ll need to answer health questions and pass underwriting to get approved for a plan. This can create some anxiety about getting through Medigap underwriting. Fortunately, hundreds of thousands of people pass underwriting to change plans each year.

Let’s take a closer look at situations that are likely to lead to approval, and which circumstances might cause an Underwriter to deny your application. We hope that the more you understand the Medicare Supplement Underwriting Process, the better you will understand the Medigap underwriting process.

STATES WITH ADDITIONAL MEDICARE SUPPLEMENT OPEN ENROLLMENT OPPORTUNITIES

Photo Of Braden Medicare Insurances' Medicare Supplement Birthday Rule Poster

In California, Oregon, and Maryland, you can change your Medigap policy during your birthday month with no Medigap underwriting. You must have an existing policy in place to qualify. Have your agent run quotes for the same plan or a lower one to see if lower rates are available. If so, completing the application is short and easy because there are no health questions.

Missouri residents have an anniversary rule. You can change Medigap carriers, while keeping the same level of coverage, during the months surrounding your Medigap anniversary. For example, you can switch from one Plan G to another without underwriting, but not from Plan G to a Plan N. The anniversary rule window generally starts 30 days before your anniversary and ends 30 days after.

Delaware Medigap enrollees can change to another plan of equal or lesser coverage 30 days before and up to 30 days after their birthday.

Illinois Medigap enrollees ages 65 to 75 have 45 days after their birthday to change their Medigap policy without medical underwriting. They can only purchase a Medigap policy with equal or lesser coverage from their current Medigap carrier.

Idaho has a birthday rule that allows Medigap enrollees to switch to a different Medigap plan of equal or lesser coverage. This window starts on their birthday and ends 63 days afterward.

Indiana residents have a “guaranteed issue” period to change to the same lettered Medigap plan with a different carrier, without underwriting. This window begins one month before their birthday and ends one month after the enrollee’s birthday.

Louisiana Medigap enrollees who are at least 65 years old can change to another Medigap policy with no health questions asked around their birthday each year. They have 63 days after their birthday to make this change. 

Nevada Medigap enrollees can change their Medigap plan to a different plan with equal or lesser coverage without underwriting on their birthday. This window starts on the 1st of their birthday month and lasts for 60 days.

Oklahoma has a birthday rule that allows Medigap enrollees to switch to another Medigap plan with equal or lower value. Enrollees will have a 60-day window that starts on their birthday.

Kentucky residents have a birthday rule that allows Medigap enrollees to change to the same plan with a different carrier. Enrollees can use this guaranteed issue right within 60 days of their birthday.

Rhode Island Medigap enrollees who have been covered by a Medicare Supplement or Medicare Advantage plan (with no gap longer than 90 days) beginning from their Medicare Supplement Open Enrollment Period, will have a 30-day window starting on their birthday to switch to any available Medicare supplement plan without medical underwriting.

Utah Medigap enrollees can change their Medigap plan to one of equal or lesser coverage with their current insurance carrier. Effective May 7, 2025, this window starts on their birthday and ends 60 days after each year.

Virginia has a birthday rule that allows Medigap enrollees to switch to a different insurance carrier offering the same coverage within 60 days of their birthday month without underwriting.

Wyoming has a birthday rule that allows people with a Medigap plan to switch to a different policy with similar or lesser benefits. Effective June 4, 2025, this window starts on the beneficiary’s birthday and lasts for 63 days.

West Virginia Medigap enrollees who have had the same Medigap policy for at least 2 years can change their Medigap policy with no health questions asked. Effective June 11, 2026, West Virginia residents have a 60-day window beginning on the first day of their birthday month to purchase a plan of equal or lesser coverage from their current insurance company or an affiliated company, unless no comparable plan is available.

  New Mexico has a birthday rule that allows its residents to change their Medigap policy to one of equal or lesser value with no health questions asked. Effective January 1, 2027, have a 60-day window beginning on the first day of their birthday month.

Connecticut, Maine*, Massachusetts*, New York, Vermont (some carriers), and Washington** have Medigap Open Enrollment year-round. However, each of these states has specific rules with its year-round Open Enrollment.

*In Maine, you must have never had a lapse of Medigap coverage lasting longer than 90 days to access the year-round Open Enrollment benefit. Also, you can only switch to a plan with the same or fewer benefits.

*In Washington, if you have a Plan A, you can only switch to another Plan A without underwriting. However, if you have any other Medigap plan, you can switch to any other Medigap plan without underwriting.

*In Massachusetts, some carriers offer continuous year-round Open Enrollment. However, there is also a guaranteed issue window between February 1st and March 31st during which you can change policies with no health questions asked.

ANSWERING QUESTIONS ON A NEW MEDICARE SUPPLEMENT APPLICATION

Now that we’ve covered Guarantee Issues, let’s dive deeper into just how the insurance companies use the Underwriting process. Each insurance company has its own Medigap application. That application will include at least one page of health questions.

There will be questions about certain conditions that you have ever had, and others that ask about a recent period of time. It’s common to see questions about the last one to three years of your health history.

 Generally, you’ll need to answer NO to some or all of the health questions as indicated in the application. Answering yes to a question results in an automatic decline with most carriers. You are not eligible for the coverage and do not need to even submit the application. There may be limited exceptions with a few carriers, depending on your state laws, so it’s always good to ask your agent about any possibilities.

That may sound harsh, but even though it is a fair description, we have found that about 7 out of 10 applicants can safely pass the Medicare Supplement Underwriting Process.

As you read through the following sections, I’ll give you some sample questions from actual Medigap carrier applications.

QUESTIONS FROM MEDICARE SUPPLEMENT APPLICATIONS

When you are looking for a Medicare supplement plan, our team can help identify which carriers are the best fit for you. They’ll know which carriers have underwriting questions that may be more lenient than others for certain health conditions. Nearly all applications will ask for information about ongoing conditions. For example:

In the past 3 years, have you been diagnosed with, received any treatment, or been prescribed any medications for the following conditions:

·        Internal Cancer

·        Heart Conditions

·        Atrial Fibrillation

·        Stroke or Transient Ischemic Attack

·        Stent

·        Chronic Obstructive Pulmonary Disease

·        Diabetes

·        Osteoporosis

·        Rheumatoid or other chronic disabling arthritis

Now that you have a feel for the type of questions, let’s look at how various health conditions or procedures could affect you.

MINOR HEALTH CONDITIONS THAT USUALLY ARE APPROVED BY MOST CARRIERS

The first thing you’ll notice is that the health questions don’t concern minor things like seasonal allergies or the flu. Likewise, they don’t really care if you had two colds last year or a urinary tract infection. Certain injuries are a non-issue as well, as long as you are fully healed and done with treatment.

Additionally, conditions like high blood pressure and high cholesterol are not an issue as long as they are not occurring alongside another more serious condition. Minor arthritis is not a problem, but as you’ll see below, a more serious form of rheumatoid arthritis would cause a decline.

Your Body Mass Index (BMI) is usually less of a factor on Medigap plans than on other types of insurance, like life insurance. Carrying a few extra pounds is not a problem as long as you are not morbidly obese. Every carrier will have underwriting guidelines about this, so your agent can check your height/weight against the company’s guidelines to make sure you don’t apply if your BMI will cause a decline. But I should mention that, although it generally will not result in you being denied coverage, you could be moved to a Standard I or Standard II rate instead of a Preferred Rate.

IF YOU HAVE SCHEDULED SURGERIES OR RECOMMENDED PROCEDURES, TAKE CARE OF THOSE BEFORE APPLYING FOR A NEW MEDICARE SUPPLEMENT/MEDIGAP PLAN

 Now we’ll begin to move into potentially declinable situations, and expensive pending procedures top the list. No insurance carrier wants to cover you just before a costly diagnostic test or major surgery.  Remember that since Medicare Supplement Insurance Carriers are responsible for paying for 20% of Surgical Costs/Procedures, these insurance carriers have a vested interest in making sure you take care of any outstanding procedure and/or surgeries completed with your current insurer, before they will want to accept the risks that have already been identified, before applying with them.

This is the case even if your pending surgery is for something non-life-threatening, such as endometriosis or having your appendix removed.  You will need to complete the surgery and any follow-up visits or therapy before a new carrier will consider you.

Some carriers may also ask for a window of time to clear after a major surgery, such as a knee replacement. Since hardware problems can occur, they may ask you to wait a year or two before submitting your application. Requirements vary, though. Be sure to ask your agent about which carriers’ questions offer you the best chance.

IF YOU HAVE HAD RECENT MAJOR CARE OR SURGERY, YOU SHOULD WAIT BEFORE APPLYING

Medigap carriers also ask questions about recent major care. If you are receiving home health care or have been hospitalized 2 or more times in the last 2 years, it is common for the carrier to decline you right on the application.

Likewise, if you are a resident in a nursing home, you may not be eligible. Since people rarely go from assisted living or nursing homes back to living on their own, your current coverage may be the coverage you need to stick with for the rest of your life.

Many people also ask us about cancer. When it comes to a major life illness, such as cancer, carriers usually want at least 2 years cancer-free and in remission before considering you. If you have had recent surgery or are still being treated, you’ll need to wait a few years before you apply.

There is at least one major carrier that will consider people with cancer or other serious conditions, but will charge you a significantly higher rate for the coverage. Sometimes we find that your current carrier is cheaper than switching to a carrier that is “rated up” for a major health condition.

IF YOU HAVE DOCUMENTED CHRONIC OR UNTREATABLE CONDITIONS OR MALLADIES, YOU NEED TO KEEP YOUR CURRENT POLICY

Some illnesses are treatable but incurable. If you have a serious illness that will require treatment forever, you’ll find that the questions on most Medigap applications will exclude you. Common examples would be dementia, chronic lung disorders, immune disorders such as RA, MS, Lupus, or AIDS, and nervous system disorders such as Parkinson’s. Osteoporosis with fractures will also be problematic. The insurance company knows these conditions will require lifetime expensive care.

Major heart disorders might also prevent you from changing insurance carriers. Arterial and vascular diseases, history of heart attack and/or strokes, stents, pacemakers, and congestive heart failure are some examples. Many carriers decline due to rhythm defects or valve problems. Kidney failure and/or organ transplants can cause a decline in most circumstances.

BORDERLINE CONDITIONS ARE NOT GUARANTEED TO BE APPROVED

Some conditions are what we call borderline. How a carrier asks and phrases the related question on their application may determine whether you can pass Medigap underwriting.

Diabetes is considered a borderline condition. If you only take oral meds or less than 50 units of insulin, you might get approved. With diabetes, carriers look at relative conditions. For example, if you have diabetes and high blood pressure with cholesterol or neuropathy, it is much harder to get approved than if you have diabetes without any related conditions.

This is one condition where I always advise you to talk to an agent. Individual Medigap underwriting guidelines for this condition vary widely. Your agent will know where you’ll have the best chance.

Another example would be mental health conditions. Generally, seeing a therapist or taking a mild antidepressant is not an issue. However, more chronic mental disorders can cause declines.

CAN YOU BE DECLINED BASED ON MY PRESCRIPTION MEDICATIONS

Medicare Supplement insurance carriers have access to national records regarding your prescription history. On your application, you must agree to allow the carrier access to these records. When the carrier pulls the report, they will check whether any prescriptions in your record indicate a declinable condition. For example, if you take a blood thinner, the insurance company wants to know why. They’ll look closely at what other medications you take that could indicate significant health problems.

 It’s important to be honest. Try hard to remember all the meds you’ve taken recently. Think back over your medication history.

If your doctor once prescribed a medication for lupus, but you didn’t mention lupus on your application, that’s a red flag. You may not consider yourself to be “taking that medicine,” but it still exists in your record. It is safer to assume they will ask about it.

THERE IS A LIST OF DECLINABLE MEDICATIONS

Carriers also have a list of auto-decline medications. These are medications that treat major or chronic illnesses. By taking these meds, you indicate a health condition that might be costly for the carrier to treat.

Sometimes a certain mix of medications is problematic. If you take diabetes meds along with high blood pressure and cholesterol meds, you may be denied. Carriers will look at your history with those meds and see how recently your dosages have changed. Frequent or recent changes can work against you.

One set of medications that can sneak up on you is pain medications. If you took a short-term round of hydrocodone while recovering from surgery, this usually won’t be a problem. However, if you have been taking it regularly, then that indicates an underlying and potentially costly problem. The Medicare Supplement carriers don’t usually like to take a chance on this. Similar problematic pain meds include fentanyl, morphine, oxycodone, and OxyContin.

 PERTAINING TO MEDICAL RECORDS

Something we’ve noticed over the years is that many people don’t always know what’s in their medical records.  Think carefully about this. If your doctor has told you that you are pre-diabetic, ask him what is written in your file. Did your doctor sugar-coat that health condition in his conversation with you?

Perhaps he told you that you were pre-diabetic, but what matters is what he wrote in the file. If your chart says diabetes, that is what the carrier will include in its assessment. If you are unsure, ask your doctor before you apply.

Also, if a doctor prescribes medication that you have no intention of filling, tell him that at the appointment and ask him not to prescribe it. Once it is prescribed, it’s in your medical record.

SUBMITTING YOUR MEDICARE SUPPLEMENT REPLACEMENT APPLICATION

Once your agent has identified which insurance company you’ll apply for, she can usually take that application from you over the phone or by emailing you a printable application. You’ll complete the application, and your agent will check that you have answered NO to all questions that require a NO.

Switching Medigap plans can take time, so I recommend applying for a future effective date 2–3 weeks out. This gives the new insurance company plenty of time to complete underwriting and give you an answer before the coverage takes effect.

Your agent forwards your application to the Medigap underwriting department. An underwriter will call you. Phone interviews are an important part of the insurance company’s decision process.

Underwriters will usually have questions related to your medical records and prescriptions you’ve taken. Occasionally, they may ask you to provide medical records if your doctor’s office is unwilling to forward them, but this is relatively rare.

Don’t volunteer any more information than what the underwriter asks you. Sometimes, we see someone get declined for information that they voluntarily offered that was not an answer to a question asked by the underwriter. Use yes and no answers to questions whenever possible.

NEVER CANCEL YOUR CURRENT POLICY UNTIL YOUR NEW POLICY HAS BEEN FORMALLY APPROVED

Don’t cancel your current coverage until your agent notifies you of your approval. Here at Boomer Benefits, we watch the pending applications daily and notify our clients immediately. Once you receive that call, you will always need to contact your old carrier to cancel that coverage.

Your insurance agent cannot cancel prior coverage for you. That rule exists to protect you. So never, ever assume that your agent is canceling your old coverage for you. Many people have contacted us over the years for help who had actually enrolled in MORE than one supplement plan from different agents before they found us. There is NEVER any reason to have double Medigap coverage.

WHAT HAPPENS IF YOUR APPLICATION IS DENIED?

So if you apply and get denied, is that the end of the world? Does it mean that everyone else will deny you, too? Not necessarily. Our team has had great success with evaluating reasons for denial and examining other carriers to see where else you might have a chance. If there are no other carriers that are likely to accept you, we’ll tell you. Then you can decide whether to keep your current coverage or explore other options, such as Medicare Advantage.

It’s worth noting that the fall open enrollment period for Medicare Part D Prescription Drug plans does not apply to Medigap plans. That period is NOT when you can apply to a new Medigap carrier and skip the health questions. If you can’t pass the underwriting because of health conditions, you will have a choice to make. You can keep your existing policy or consider the Medicare Advantage plan, which has no health questions.

WRAPPING THINGS UP

Going through Medigap underwriting can be a scary time. With Braden Medicare Insurance, you don’t have to go it alone. We’ll choose the carrier where you have the best chance. We don’t want to waste your time. If we believe you can’t pass Medigap underwriting questions right now, we’ll be the first to tell you.

Sometimes waiting a few months can make a difference. The worst thing is getting declined and being unsure whether you have any other options. Working with us means you’ve got someone to advise you of your options. 

REMEMBER

·        There is no penalty or repercussion for applying for a Medigap plan and being denied due to underwriting. So, it doesn’t hurt to try.

·        Some carriers may be more lenient with their underwriting process, so it doesn’t hurt to try with another carrier if one denies you.