Medicare 101

Medicare Supplement Health Underwriting and why it matters


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Being responsible for an uncapped 20% of medical costs is a big deal.

Felicia recently got in touch with us for help. She received poor advice from the Medicare office and from medical practitioners. She was told that the Medicare Supplement plans are better for her situation. Because she is going through cancer treatment, her co-pays were high for all the various treatments, visits, and procedures. As a result, she disenrolled in her Medicare Advantage plan, and in the new year looked to sign up for a Medicare Supplement plan. In January, after her Medicare Advantage plan had stopped, she tried to sign up for a Medicare Supplement plan. This is where the problems started. She discovered she only had Original Medicare, which pays just 80% of her medical costs, meaning that each of her treatments cost her $1,400 out of pocket. The Medicare Supplement plan would pay the $1,400, or 20% of her medical costs, right?

The problem she faced is Health Underwriting. In simple terms, she had to answer these health questions:

  1. Within the past 2 years, did a medical professional provide treatment or advice to you for any problems with your kidneys?
  2. Within the past 2 years, did a medical professional tell you that you may need any of the following?
    1. organ transplant
    2. back or spine surgery
    3. joint replacement
    4. surgery for cancer
    5. heart or vascular surgery
  3. Within the past 90 days, were you hospitalized as an inpatient (not including overnight outpatient observation)?
  4. Are you currently being treated or living in any type of nursing facility other than an assisted living facility?
  5. Within the past 2 years, did you have (as determined by a medical professional) a Heart Attack, Stroke, Transient Ischemic Attack (TIA) or mini-stroke?
  6. Within the past 2 years, were you diagnosed, treated, given medical advice or prescribed medications/refills by a medical professional for any of the following conditions?
    1. Artery or Vein Blockage
    2. Peripheral Vascular Disease (PVD)
    3. Cardiomyopathy
    4. Congestive Heart Failure (CHF)
    5. Coronary Artery Disease (CAD)
    6. Chronic Obstructive Pulmonary Disease (COPD) or Emphysema
    7. End-Stage Renal (Kidney) Disease or Require Dialysis
    8. Chronic Kidney Disease
    9. Diabetes, but only if you have circulation problems or Retinopathy
    10. Cancer including Melanoma (but not other skin cancers)
    11. Leukemia and Lymphoma
    12. Cirrhosis of the Liver

As you can see, the questions are fairly comprehensive in their reach of pre-existing conditions, through asking you whether you have been prescribed or received advice on any of the chronic conditions as listed. Different Medicare Supplement insurance carriers do ask different questions, so it’s worthwhile reviewing the different questions if you really need to sign up for a Medicare Supplement plan.

We ended up helping Felicia get on to a Medicare Advantage plan that allows her to continue to see her doctors, with an aim to see if we can help her get a better plan in the next Open Enrollment Period that starts in October.

Guaranteed Acceptance
If you are in your Initial Enrollment Period, the 7 month period surrounding your 65th birthday, you have Guaranteed Acceptance and can sign up for any plan. Make sure you understand that you will no longer have guaranteed acceptance after this period in general. Make sure you get proper coverage during this period.

After this period, if you do not pass underwriting, you will not be able to get a Medicare Supplement Plan. The key is to make sure you’re wholly covered before you disenroll in your current plan. If you choose a Medicare Advantage plan to start, you would need to pass underwriting to get on to a Medicare Supplement plan in the future.

Exception: In New York and Connecticut, you have Guaranteed Acceptance all year round.

Birthday Rule
In California and Oregon, once on a Medicare Supplement plan you can change to a plan of equal or lesser coverage for the 30 days after your birthday each year.

Our take:
Being responsible for an uncapped 20% of medical costs is a big deal, so get professional help if you don’t understand the complexities of Medicare. You’re not expected to understand everything, and the government is not going to help you.

Have any questions?
Just get in touch with one of our Heroes that would be happy to help you! We are unbiased independent brokers contracted with all of the major health insurance companies. We are 100% free to you and the prices are the same as if you went directly to the health insurance companies, but with us as your Medicare concierge we can continue to guide you in your journey.

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