Can I Pass Medigap Underwriting?

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 explore which situations are likely to result in approval and which circumstances might result in roadblocks to successfully changing. This will help you better understand your Medigap eligibility.

Guaranteed Issue Situations – No Health Questions

Everyone gets an open enrollment period to enroll in Medigap when they turn 65 and/or first activate Part B. If you’ve been doing your research, you now know that this 6-month open enrollment window means you can apply without answering any health questions. It’s a one-time window though, and then it’s gone.

Fortunately, there are several other situations in which you are guaranteed the right to buy a comprehensive Medigap policy without underwriting.  We call this Guaranteed Issue or “GI”.  Here are a few common GI examples:

• Leaving other coverage, usually employer coverage at a large company, within the last 63 days.
• You tried a Medicare Advantage plan for the first time, and within 12 months you wish to dis-enroll and get Medigap instead.
• You have a Medicare Advantage plan or Medicare Select policy, and you have moved outside your plan’s service area.

In all of these situations, you have a small window to purchase a Medigap policy without answering any health questions.

There are a few other things that result in GI periods.  Ask your insurance agent to check and see if any apply to you.  Working with an experienced agent who specializes in Medicare is your best bet for uncovering situations where you might qualify for GI.

States with additional Medigap Open Enrollment windowsEmpty heading

In California, Oregon, and Maryland, you can change your Medigap policy during the month of your birthday with no Medigap underwriting. You must have an existing policy in place to qualify. Have your agent run quotes for your same plan or a lesser plan to see if lower rates are out there. 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 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, as of January 1, 2026, can change to another plan of equal or lesser coverage 30 days before and up to 30 days after their birthday.

Illinois Medigap enrollees who are ages 65 to 75 have 45 days after their birthday to change their Medigap policy with no 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 within 60 days of their birthday to change to the same lettered Medigap plan with a different carrier, without underwriting. 

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 that has equal or lesser coverage without underwriting around 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 change to another Medigap plan of equal or lesser value. Enrollees will have a 60-day window that starts on their birthday.

Kentucky residents are given a birthday rule that allows Medigap enrollees to change to the same Medigap 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 change to a different insurance carrier that offers the same coverage within 60 days after 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.

There are also states like Connecticut, Maine*, Massachusetts*, New York, Vermont (some carriers), and Washington** where you 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 – March 31st that you can use to change policies with no health questions asked.

Medigap Underwriting: the Health QuestionsEmpty heading

Now that we’ve covered the GI situations, let’s talk about HOW the insurance companies underwrite. Each insurance company has its own application for Medigap. 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 where they ask about a recent period of time. It’s common to see questions about the last two years of your health history.

Generally, you’ll need to be able to answer NO to some or all of the health questions as indicated on 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.

The good news? Here at our agency, we find about 75% or more of all underwritten applications get approved.

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

Sample Underwriting Question for Medicare Supplement Applications

When you are looking for a Medicare supplement, our team can help identify which carriers best fit you. They’ll know which carriers have underwriting questions that may be more lenient than another 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 disabling arthritis

Now that you know the kinds of underwriting questions you may be asked, let’s see how various health conditions or procedures could affect you.

Minor Health Conditions – Likely Approval

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.

Often things like high blood pressure and cholesterol are not an issue either 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.

Body Mass Index (BMI) is usually more relaxed 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.

Pending Surgeries and Treatments – Finish them First

Now we’ll begin to move into potentially declinable situations, and expensive pending procedures top the list. Obviously, no insurance carrier wants to cover you just before a costly diagnostic test or major surgery.  Remember that Medigap carriers will pay for 20% of that surgery. They want you to get that done with your old carrier before you apply with them.

This is the case even if your pending surgery is for something non-life-threatening – such as endometriosis or a gall bladder removal.  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 clear after a major surgery, such as knee replacements. 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.

Recent Major Care – You’ll Need to Wait

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 live 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 treating, 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.

Chronic, Incurable Health Conditions – Keep Your Current Coverage

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 carriers. Arterial and vascular diseases, history of heart attack and/or strokes, stents, pacemakers, and congestive heart failure are some examples. Many carriers decline for rhythm defects or valve problems. Kidney failure and/or organ transplants can cause a decline in most circumstances.

Borderline Conditions – Could Go Either Way

Some conditions are what we call borderline. Depending on the carrier and how they phrase the related question on their application, you may or may not be able to pass the Medigap underwriting.

Diabetes is an example of 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 because individual Medigap underwriting guidelines on this vary quite a bit. 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 anti-depressant is not an issue. However, more chronic mental disorders can cause declines.

Auto-Decline Medications and Script Checks

Medigap 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 first look to see if there are any prescriptions in your record that may 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, and you can be sure they’ll ask about it.

Auto-Decline Drug Lists

Carriers also have a list of auto-decline medications. These are medications that treat major or chronic illnesses. By virtue of taking these meds, you indicate a health condition that might be expensive 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 Medigap carriers don’t usually like to take a chance on this. Similar problematic pain meds include fentanyl, morphine, oxycodone and oxycontin.

A Word about Medical Records

Something we’ve noticed over the years is that average 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 a 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 a Medigap Application

Once your agent has identified which insurance company you’ll apply with, 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 to make sure that you have answered NO to all the questions that require a no.

Switching Medigap plans can take time, so I recommend applying for a future effective date that is 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. The phone interview is an important part of a carrier’s decision process.