medical underwriting Archives

Beware of Post-Claims Underwriting

Having health insurance is necessary for keeping you protected in the event of an emergency or accident. A full-coverage plan is usually your best bet, but in some cases you might decide to opt for a short-term plan. For example, if you missed Open Enrollment and need a plan quickly you might choose one of these plans for convenience. Or, if you are healthy and rarely visit the doctor, you might choose one of these plans to save money on premiums, since they are usually less expensive than traditional plans.

caucasian hand with a pen filling out a survey — *Insurance companies are no longer allowed to medically underwrite you during the sign-up process, but short-term plans can.*

Unfortunately, if you are not careful when picking out your short-term health plan, you might end up dealing with post-claims underwriting. Some insurance companies bait consumers into choosing their short-term plans, only to turn around and use this tactic to deny customers their insurance payouts after a claim is made. To avoid post-claims underwriting, you have to know what it is; you should also work with a reputable agent to know that you have the right plan from the right insurance company.

Medical Underwriting

Before the protections of the Affordable Care Act (ACA), major medical health insurance plans could force customers to undergo the medical underwriting process before choosing whether to insure them. This meant that you would have to fill out a questionnaire based on your pre-existing health conditions, and if you were considered high-risk, they could deny you coverage or charge you a higher premium based on your medical history.

Although the ACA ended medical underwriting for major medical health insurance plans in 2014, it still applies to short-term health insurance plans and Medicare Supplement Plans if someone enrolls after their Initial Enrollment Period.

Post-Claim Underwriting

Short-term health plans are not subject to any ACA regulations, so with these plans, insurance companies can still use the underwriting process to choose who they want to insure and how much to charge for coverage. But in some cases, instead of being thorough in the underwriting process, insurance companies that offer short-term plans will not fully evaluate the risk of a customer before agreeing to insure them. Instead, the insurance company will evaluate the risk of the customer after a claim is made. This is called post-claims underwriting, and it can end up costing you thousands in medical expenses.

When using post-claims underwriting, insurance companies will look for a reason to deny claims by asking questions that should have been asked before the policy was sold. Generally the insurance company will do this to try and take your premium payments without intending to pay out on your claims. They will issue you a policy with little to no investigation, giving you a simple application with yes or no answers. For example, they might simply ask you if you are in good health; if you check yes, then, once you file a claim, they will investigate your prior health issues and will use your answer against you. If you have a stroke, for example, while covered by the plan, the insurance company might investigate your actual health status prior to the stroke and would use any information they found to deny your claim.

Avoiding Post-Claims Underwriting

Unfortunately, some health insurance companies that offer short-term plans still engage in the practice of post-claims underwriting. To avoid being swindled into buying one of these plans, there are some steps you can take. Before signing up with a company, examine their application and ask questions if you don’t understand it. This may not be enough, though; the best way to make sure that you are fully insured and protected is to work with an insurance agent. EZ.Insure works with some of the top rated-companies in the country, and will go through the application process with you. Our agents are honest and will make sure that you understand your policy, and that you won’t have any rugs pulled out from under you when you file a claim. We might even be able to find a health insurance plan that is not allowed to medically underwrite at a more affordable price than that of a short-term plan!

Avoid confusion and any possibility of being denied coverage in the future by working with an EZ agent. Our agents are highly-trained, honest, and work with your best interests in mind. To get free quotes on plans in your area, simply enter your zip code in the bar above. Or to speak directly to an agent, call 888-350-1890.

Is Medicare Underwriting Necessary?

Medical underwriting is a process when a private insurance company reviews your medical history to determine whether they will provide you with coverage, how much to charge you, and whether to set a waiting period before coverage begins. If you have a lot of medical issues, you may have to pay more for coverage or even be denied approval. Pre-existing conditions will come up and can cost you greatly.

denied word in red — *After your Medicare underwriting is complete, companies decide whether to accept you, or deny you coverage due to your pre-existing conditions.*

Medicare Supplement plans help pay for out of pocket expenses such as copays, coinsurance, and deductibles. When

you sign up for a Medicare Supplement plan, you may need to go through the underwriting process. It all depends on when you decide to sign up for a supplement plan. To answer the question if Medicare underwriting is necessary, both yes and no. Find out how to avoid Medicare underwriting, and if you do have to go through it, then what it entails.

The Only Time To Avoid Medicare Underwriting

During the Medicare Supplement Open Enrollment Period is when you have “guaranteed issue rights.” Guaranteed issue means that you will be accepted into any plan regardless of your health condition or pre-existing conditions. During this time, you have a one-time guarantee when companies cannot deny you or charge you more due to a pre-existing condition. The Medicare Supplement Open Enrollment Period is a six month period that begins the first day of the month you turn 65 years old, and enrolled in Medicare Part B.

When You Need To Be Underwritten

If you apply for a Medicare Supplement plan after your Medicare Open Enrollment Period has passed, then you may have to go through the underwriting process. In addition, when you are switching Medicare Supplement plans, you may have to go through the underwriting process. If a Medicare Supplement plan accepts your application, the insurer can choose to make you wait 6 months before covering a pre-existing condition. This is known as a “look-back period,” or “pre-existing wait period.”

The Underwriting Process

Private insurance companies will have extensive health-related questions on their applications. It will go over your entire medical history, both past and present. If you have a pre-existing health condition that may be expensive for the company to cover, they can choose to deny your application.

white paper that says checklist with boxes down a line with checkmarks in them. — *During the Medicare underwriting process, companies will go through your medical history and check off which conditions may be considered an expensive health risk for them to cover.*

If you have a health condition that needs constant attention, chronic, or incurable, then you may be denied. Certain medications can also be a reason for denial, especially for the incurable or chronic health conditions, simply because it will be too expensive for the insurers to cover. Often times minor conditions such as BMI, high blood pressure, and cholesterol are not issues for carriers. If you have pending surgeries or treatments, then it is best to get them done before applying. Serious health conditions such as rheumatoid arthritis, dementia, chronic lung disorders, lupus, MS, major heart disorders, and kidney failure will be an automatic denial of coverage for the company.

If you are still within your Medicare Supplement Plan Open Enrollment Period, then great, no better time to get started and sign up for a plan. If you have passed this guaranteed issue window, you can still apply with caution. And if you get denied, then it is not the end of the world, our agents will search through all available Medicare Supplement plans and help you.

EZ.Insure has highly trained agents who will search through all the Medicare Supplement carriers in your region, whether you are within the open enrollment period or not. Your personalized agent will compare all the plans, their coverage, and their quotes. To get started, you can enter your zip code in the bar above, or speak to an agent directly by emailing Replies@Ez.Insure or calling 855-220-1144. We will be by your side throughout the process, walking you through it, while providing you with the best advice and options.