Can Your Client Pass Underwriting for a Medicare Supplement Policy?

When you have a client who needs to go through underwriting for a Medicare Supplement policy it's important to interview them beforehand. Typical health questions on a Medicare Supplement application will ask if your client has ever had certain health conditions during a specific period, and generally that look back period is two years. Every carrier is different and has their own specific underwriting guidelines, so it's important to know them before applying. Oftentimes answering "yes" to certain health questions can result in an automatic decline. To prevent that from happening, be sure to get a complete picture regarding your client's health. Below is an example of a typical underwriting question on a Medicare Supplement application:

​In the past two years have you been diagnosed with or treated for any of the following conditions?

• Atrial Fibrillation
• Cancer
• Chronic Obstructive Pulmonary Disease (COPD)
• Diabetes - Type 1 or 2
• Heart Conditions
• Hypertension
• Rheumatoid Arthritis
• Stroke

Declinable Situations

Certain conditions such as minor high blood pressure and even high cholesterol are typically not an issue for a Medicare Supplement application. Being overweight is also not usually an issue, if your client is not morbidly obese. 

Some insurance carriers require that a certain window of time has passed after a major surgery, before accepting an application. If your client has had recent surgery or is still being treated, you should wait before submitting the application. If your client has been hospitalized in the last few years, is receiving home health care, or if they live in a nursing home, they may also be declined for coverage. Again, every carrier is different, and you need to check their Underwriting guidelines.

​When it comes to cancer, Medicare Supplement carriers usually want your client to be cancer-free for at least two years before they will accept them. However, there are certain carriers who will approve clients with cancer or other serious conditions, but they will charge higher rates for coverage. Therefore, it's wise to run quotes for multiple carriers and review their underwriting guidelines to determine the best course of action.

Diabetes is a condition that could result in a decline, but it depends upon the situation. Underwriters look at the entire picture. For example, if your client has diabetes and high blood pressure and high cholesterol, it's much harder to get approved than if they just have diabetes without any other health conditions.

​It's important to advise your client that insurance carriers have access to national records with regards to prescription history. Encourage your client to remember any and all medications they've been prescribed. Reviewing their medical history is incredibly important. If their doctor has previously prescribed a medication for a certain condition, and you don't mention it on the application, that’s a red flag in the underwriting system. Even if your client never filled the prescription or never took the medication, it needs to be explained.

Submitting the Application & Phone Interview

​When you're ready to submit the application be sure to make the policy effective date a few weeks in advance. This gives the Underwriter plenty of time to review the application and the answers to the medical questions. After the application has been reviewed, an Underwriter will call your client to conduct a phone interview which is a very important part of the decision process. It's important to remind your client to simply answer the questions that the Underwriter asks. Volunteering additional information or over-sharing could cause problems with the application process.

Be sure to let your client know that it's important NOT to cancel any current coverage until after you've been notified that their application was approved. Once it's approved, they will need to call and cancel their existing coverage. 
 
If your client gets denied, it's worth exploring other carriers. Always keep in mind that your client may be better off keeping their current coverage. In addition, remind them that there are no repercussions for applying for a new Medicare Supplement policy in the future.

If you have questions regarding underwriting, please reach out to us and we'll be happy to assist you.

By Carolyn Portanova

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