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How does an insurance company medically Underwrite someone on Medicare?
If an insurance company medically underwrites someone on Medicare, it means they are assessing the individual's health status and medical history before offering them a Medicare supplement (Medigap) policy AND after their Initial Enrollment Period (IED). Here's how the process generally works:
1. Medigap Application and Health History: When you apply for a Medigap policy, the insurance company will typically ask you to fill out an application that includes questions about your health history and any pre-existing medical conditions you may have. They may also ask about your prescription medications and recent medical treatments.
2. Review of Health Information: Based on the information provided in your Medigap application, the insurance company will review your health history to determine your level of risk. They may consider factors like chronic conditions, past surgeries, hospitalizations, and other medical treatments.
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3. Underwriting Decision: After reviewing your health information, the insurance company will make an underwriting decision. They may choose to do one of the following:
4. Offer Coverage: If they believe you are a relatively low-risk applicant, they may offer you a Medigap policy at their standard rates.
5. Offer Coverage with Higher Premiums: If they consider you to be a higher risk due to pre-existing conditions, they may still offer you a policy but at a higher premium rate. This is known as medical underwriting with premium loading.
6. Deny Coverage: In some cases, the insurance company may decide to deny you coverage altogether based on your health history.
7. Guaranteed Issue Rights: It's important to note that there are certain situations where individuals have guaranteed issue rights, which means insurance companies cannot deny coverage or charge higher premiums based on health conditions. These situations include the Medigap Open Enrollment Period and other specific circumstances that trigger guaranteed issue rights.
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8. State Regulations: Medigap policies are regulated at the state level, and the rules around medical underwriting can vary. Some states have more strict regulations that limit the extent to which insurance companies can use medical underwriting.
MedHelpCenter.us recommends that you call the Senior Health Insurance Agency at 813-592-8568 for further explanation.
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