Definition. Medical underwriting is when an insurance company reviews your health history before deciding whether to sell you a Medigap policy and at what price. Outside a guaranteed-issue window, a company can deny you, charge more, or make you wait for pre-existing condition coverage.
What it means
Underwriting usually means a health questionnaire and a check of your prescription history. Outside a protected window, a Medigap company may:
- Decline your application because of your health history.
- Charge a higher rate.
- Make you wait (up to six months) before it covers a pre-existing condition.
Federal law protects you during your six-month Medigap Open Enrollment Period and in specific guaranteed-issue situations, such as losing employer coverage or your Medicare Advantage plan leaving your area. Medicare Advantage and Part D plans never use medical underwriting.
In Oregon
Oregon adds protections beyond federal law:
- Birthday rule. If you have a Medigap policy, you can switch to another policy with the same or lesser benefits, from the same or a different company, from 30 days before to 30 days after your birthday each year. The company can't deny you or price the policy based on your health (Oregon Administrative Rules 836-052-0143). It doesn't apply to policies issued before 1990.
- Under 65. People with Medicare because of a disability get a six-month Medigap open enrollment when they enroll in Part B, with every plan the company sells and a premium no higher than it charges people who are 65 (OAR 836-052-0138).
- Guaranteed-issue events. Oregon's list includes the federal events, such as a Medicare Advantage plan ending, generally with 63 days to apply (OAR 836-052-0142).
Use the birthday rule timing tool to find your window.
Sources
- Oregon Administrative Rules 836-052-0143 — Annual opportunity to select another Medicare supplement policy
- Oregon Administrative Rules 836-052-0138 — Open enrollment
- Oregon Administrative Rules 836-052-0142 — Guaranteed issue for eligible persons
- Medicare.gov — Medigap (Medicare Supplement Insurance)
Frequently asked questions
Do all Medigap companies underwrite the same way?
No. Companies ask different health questions and decide differently. A licensed insurance agent can explain how the companies they work with handle applications, and you can request a call from a licensed insurance agent.
Does medical underwriting apply to Medicare Advantage or Part D?
No. Medicare Advantage and Part D plans can't turn you down or charge you more because of your health. Underwriting is a Medigap issue.
When can I buy Medigap in Oregon without underwriting?
During your six-month Medigap Open Enrollment Period, when a guaranteed-issue right applies (for example, your Medicare Advantage plan leaves your area), and each year around your birthday if you already have Medigap and switch to a policy with the same or lesser benefits.
Medicare in your Oregon county
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