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Understanding Underwriting

Senior man explaining underwriting to female friend as they share coffee.

Understanding The Process

Endless phone calls, mile-high stacks of mail, paid talking heads on TV all telling you they can save you money. Saving money is always a possibility, but understanding the process of securing a new Medicare supplement will give you an idea of the best time of the year to apply for new or different coverage.

Medicare beneficiaries may shop their Medicare Supplements themselves at any time of the year for lower premiums granted you make it through underwriting.

Several factors play into passing the underwriting to become approved for a lower cost on your Medicare supplement. No two Medicare Supplement companies are created equal, and each has its guidelines and restrictions.


Understanding the general rules to pass underwriting standards can seem very confusing, but the truth is, some restrictions apply across all companies.

It is best to evaluate your situation and be realistic. Sometimes it does not seem right morally to decline coverage, but you must understand the insurance company’s viewpoint. The concept of insurance is the same no matter the space; it is a transference of risk.

These companies MUST pay the deductibles and claims. The only way to calculate this risk is to ask qualifying questions. This is the defining concept of underwriting. “Do you, the applicant, qualify based on the risk assessment we have put into place to protect us, the company, from potential insolvency?”

Insolvent companies can help no one. That is why underwriting is essential.

Concerned senior woman trying to understanding the underwriting process of medicare better.
Understanding the general rules to pass underwriting standards can seem very confusing, but the truth is, some restrictions apply across all companies.

Underwriting is subjective to the company, but usually, the conditions below will result in a declined result.

  • Current or recent health issues: Usually, lung and respiratory disorders, heart and cardiovascular disorders, cancer diagnoses, diabetes with insulin use, kidney issues, declinable drugs, and autoimmune diseases are the significant factors in instant declinations. Certain conditions have predetermined lookbacks on surgery and diagnoses, resulting in declined applications.
  • Specific Declinable Prescriptions: Looking back more to the insulin example above. Diabetes with metformin use is usually not a problem unless specific nerve or cardiovascular issues are accompanied. Each company has a declinable drug list. It is of utmost importance to disclose your prescriptions to your agent. Your RX history is readily available, so there are no secrets in underwriting. Always be honest about your medicines to receive the best help possible promptly.
  • Incomplete Telephone Interviews: It is commonplace for an insurance company to reach out and confirm the answers received on the original application. This is not always the case in more expedited acceptance, but if you have applied for a medicare supplement and you receive a call from an unknown number, more than likely, it is the company reaching out.


*Failure to complete these calls WILL result in a termination of the application rendering it incomplete. Your agent will be notified, and they should reach out to you. Generally, there is a 30-day window to complete these.

Ask your agent where the call may be coming from if you are cautious of answering unknown numbers.

Not all conditions are created equal, so ask your agent before you assume you are unable to lower your monthly premium. You will not know until you try.

The information above does not discourage you from reaching out to see if you have a better option. It is only to inform you of why a company may decline someone.

We are blessed as agents who work with companies that want to help folks. We build relationships with these groups to ensure the services we offer are precisely what we say they are, and so we have faster avenues to solving an issue if one did arise.

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