3 Questions About Medicare Supplement Underwriting in Omaha
#1. Can You Change Your Medicare Supplement Without Underwriting in Omaha?
Outside of your Open Enrollment or Guaranteed Issue (GI) situation, you must go through Medicare Supplement underwriting in Omaha. This means all of Nebraska and Iowa as well. I had an incredible case a couple of years ago.
Several financial advisors refer their clients to me for their Medicare needs. One young man referred to me was 92. He had been on the same Medicare supplement since he was 65. His Plan F was $565 per month. I about fell out of the chair when he told me how much. The agent hadn’t contacted him in decades–probably dead!
I was concerned that he might not pass the Medicare Supplement underwriting questions here in Omaha, but I took an application—the same exact coverage he currently had. In a couple of days, I got the email from the insurance company he was approved and the policy issued. I saved him over $3,000 a year. I feel bad he had been neglected all those years and had overpaid thousands of dollars.
That’s why you want to check on your Medicare Supplement regularly. It may save you money to change. All you have to do is fill out the Medicare Supplement underwriting application and answer a few questions.
#2. What Is Medicare Supplement Underwriting in Omaha?
Insurance is about covering risk. Actuaries are super-mathematicians who figure out the risk. They mathematically determine the odds that something will happen and how much that something will cost.
What are the odds you will be in a car accident? How much will it cost? What are the odds you will get sick, and how much will that cost?
Actuaries use the statistical data of tens of thousands of people and your personal medical history to determine the probability something will happen or not. They also figure out what that something will cost—figuring that all out is as much an art as a science.
Medicare supplement underwriting questions attempt to uncover your current health. Actuaries ask the questions, collect data and “guess-timating” costs. The purpose of Medicare Supplement underwriting in Omaha is to determine your eligibility and the cost.
An applicant can qualify for a Medicare Supplement in one of three ways. Federal and State laws guarantee an “open enrollment” to those turning 65 or enrolling in Medicare Part B for the first time. During this time, anyone may apply and purchase a supplement without answering any health questions. The insurance company can neither deny nor rate you based upon your health. I am focusing on underwritten policies, so I will leave this to another discussion.
The second way is through Guaranteed Issue (GI). Guaranteed Issue can come in several ways. But, again, I will leave that to another blog.
The third way to qualify for a Medicare Supplement is by going through the underwriting process. An insurance company determines your eligibility for health insurance coverage based upon listed criteria.
What A Terrible Question!
The first question: “What is your height and weight, please?”
Most people–including myself–are not at the weight we would like or should be. All of the Medicare Supplement underwriting in Omaha have a chart for height and weight. Some companies are more generous than others. Along with other factors, we consider weight when we start an application. Some of our clients are not tall enough for their weight, so we guide them to certain companies.
If you are extremely short for your weight, it could be an issue. Always call and find out. Sometimes I have had clients delay and delay because they have convinced themselves that they will lose that thirty pounds before they apply. The thirty pounds never comes off. I convince them to make a Medicare Supplement underwriting application anyway, and it turns out the thirty pounds didn’t matter. As Nike says, “Just do it!”
I had another client last summer lose about 4o pounds. A few months before, the insurance company denied her coverage. After a wonderful weight loss regime, she passed Medicare Supplement underwriting and saved almost $1,000.
Medical History – Knockout Questions
I don’t think “knockout questions” is official actuarial language. But, it’s the language insurance agents use because these questions knock people out of the running for a supplement.
These are some examples of Medicare supplement underwriting questions for preexisting conditions.
- Treated for or advised to have bone marrow or organ transplant
- Diagnosed or treated for AIDS
- Treated for or diagnosed as having internal
- Cancer, melanoma, leukemia, Hodgkin’s disease, or lymphoma
- Treated or diagnosed as having congestive heart failure
- Alzheimer’s disease, Organic Brain Syndrome, or Senile Dementia
- Treated for or diagnosed as having Amyotrophic
- Lateral Sclerosis (ALS), Parkinson’s disease, or Multiple Sclerosis
- Cirrhosis of the liver, chronic renal failure, kidney failure, or have had dialysis
- Diagnosed as having Hepatitis C, Lupus or Crohn’s disease
- Diagnosed with COPD and/or Emphysema
- Requiring any injectable medications for treatments
- Uses or has oxygen tank for lung disease
- Hospitalizations within the past 60 days or three or more within the past two years
- Requiring assistance for dressing, bathing, toileting, walking, or is bed-ridden
- Radiation or chemotherapy treatments within the past two years.
- Diagnosed with Bipolar or Schizophrenia
- Diagnosed with Myasthenia Gravis
- Peripheral Vascular Disease
These are some of the medical history questions that would result in an immediate denial. This is not a complete list. Some Medicare Supplement underwriting in Omaha have more questions, but this list gives you a good idea of what is permissible or not.
Again, the individual insurance company can make a big difference. Not all insurance companies have the same Medicare supplement underwriting guidelines. They vary from company to company.
There is one company that denies coverage if you have rheumatoid arthritis. Another company will cover rheumatoid arthritis if it is not currently debilitating. Again, knowing the subtleties of the company’s Medicare supplement underwriting guidelines makes a difference.
#3. Can I Still Get My Medicare Supplement Underwritten In Omaha If I Have Diabetes?
Diabetes is problematic, depending upon your situation. The company’s Medigap underwriting questions will determine if it makes sense to apply. Some companies will outright deny coverage if you are on insulin. With other companies, the amount of insulin will make a difference. Some put a limit of 50 units, and above that amount, they deny coverage. Quantity is critical.
With other companies, weight may be the deciding factor when you have diabetes.
Medigap underwriting questions can be a complex web of guidelines varying from company to company. On top of that, companies change their guidelines. A couple of years ago, I had one insurance company that was my go-to company for people with diabetes. Then, it made its eligibility process more restrictive. An insurance company can change at any time for new applicants.
Future procedures Questions
An issue that most people do not think about is future procedures. I have had many an application torpedoed because the client did not mention they were planning a knee replacement in a couple of weeks.
Insurance companies will not take on known expenses, such as pending surgeries or procedures. They want those completed, the patient discharged from treatment, and everything working without side effects before taking on a new client. Before applying for a Medicare supplement, the patient must complete any joint replacements, cataract surgery, hernia surgery, etc.
People have asked me what if a future procedure is uncertain. For example, your knee is not in good shape. You have discussed knee replacement with your primary care physician, but the doctor did not recommend surgery. At least, it is not an order in the medical records. After a few months on the new Medicare Supplement, you have a knee replacement. Could that be a problem? Absolutely!
The insurance company could go back to the application you signed and say you did not disclose a pending surgery and thus refuse to pay for the procedure. That is a real possibility.
On the other hand, the insurance company cannot hold you captive forever from having any procedures. Six months or a year is usually the term limit. If you have a procedure outside of the initial six months, the company may not question it. Situations do come up, so it is not possible to foresee every possible contingency.
Changing In Health Condition
I remember a prospective client I visited with about changing supplements. She was scheduled for a hip replacement, so we couldn’t fill out an application. For various reasons, she delayed the procedure for several months. Every time I called back, the surgery had been delayed. Finally, she had surgery, so we set a date to complete the Medicare Supplement underwriting application.
It turned out there were complications. She had to go to physical therapy for several months. Each time I called, the physical therapy had been extended. Finally, the doctor released her from physical therapy, so we scheduled an appointment.
As I began the Medicare Supplement underwriting application, she disclosed that she was recently diagnosed as bipolar and on medication for her condition. I stopped the application.
Depression and other mental ailments are common. A person can pass underwriting who has depression, bipolar, etc. Insurance companies approve people with depression all the time. The issue, in this case, was the recency.
An insurance company is looking for stability in a condition. How long has the person had the condition? How has the treatment gone? Are there side-effects or costly consequences? All of those elements go into consideration. For example, someone recently diagnosed would probably not pass.
Health insurance is not cheap. So I try to help my client keep those costs down. One way I do that for my clients on Medicare Supplements is to check in with them on a regular basis to see what they are paying. Then, if I can save them some money, we make an application with another company.
In that process, I navigate the Medicare Supplement underwriting guidelines for some of my clients with health issues. It is not always easy. Weight, history, current conditions, medications, and future procedures all come to bear on what can or cannot be done. I’m here to help make getting Medicare insurance for you or your loved ones in the Omaha Nebraska area a little less painful.
If you need help navigating the labyrinth that is Medicare Supplement underwriting in Omaha or anywhere, please give us a call at 402-614-3389.