Medigap underwriting: what insurers ask when you apply outside open enrollment

Outside your Medigap open enrollment and guaranteed issue situations, insurers in most states can ask health questions and decline or rate you. Knowing what they ask helps you decide whether to apply.

Typical questions

• Are you currently in a hospital or nursing home, or scheduled for surgery?
• In the past two years, have you been diagnosed with or treated for cancer (other than some skin cancers), heart attack, stroke, COPD, kidney failure, Alzheimer's or dementia?
• Do you use oxygen or a wheelchair?
• Are you taking certain medications (insulin at high doses, some heart or psychiatric drugs)?
• Height and weight.

Each insurer has its own list. A condition that leads to a decline with one company may be accepted by another.

Look-back periods

Most questions ask about the last two to five years. A condition treated eight years ago may not matter; one treated last year often will.

Before applying

1. Gather your diagnoses and medications.
2. Compare several insurers' questions; a good agent can tell you which company is likely to accept you.
3. Do not cancel your current coverage until the new policy is issued.
4. Answer honestly: misstatements can lead to rescission.

When underwriting does not apply

During your six-month Medigap open enrollment, under federal guaranteed issue rights, under the trial right, and under state rules such as Washington's.

Questions people ask

Can a Medigap insurer turn me down?

Outside open enrollment and guaranteed issue situations, in most states, yes.

What conditions usually cause declines?

Recent cancer, heart attack, stroke, COPD, dementia and kidney failure are common examples.

Is there a waiting period for pre-existing conditions?

Up to six months federally; Washington limits it to three.

Should I cancel my old policy before applying?

No. Wait until the new policy is issued.

Independent educational site. Not affiliated with or endorsed by the U.S. government, the federal Medicare program, or any insurance company. Figures are 2026 amounts published by CMS unless noted; check Medicare.gov for your situation.