Ask the Medicare Specialist

QUESTION:

I’m considering moving from an Advantage Plan to a Supplement. In several of your columns you’ve mentioned that Supplement companies can deny your application for certain medical conditions. Can you be specific on what those include?

ANSWER:

Supplement companies can indeed deny an application based on your current and previous health conditions. I will give a list of the questions one of our more popular companies ask. But first I want to go over a couple scenarios where Supplement companies are NOT allowed to ask any questions and are required to accept you, healthy or not. I also want to discuss the differences between Advantage Plans and Supplements as it pertains to underwriting.

Whenever someone goes on Medicare Part B for the first time, be that due to turning 65, applying for Part B after the age of 65, or getting Medicare pre- 65 two years after being awarded Disability, there is a window of time called “Open Enrollment” when Supplement companies cannot deny an application.

If one already has Part B and is losing insurance from an employer or a company they retired from, Supplement companies also can’t deny an application regardless of health, due to what is known as a “Guaranteed Issue” period. Keep in mind the loss of coverage can be either voluntary or involuntary.

As far as Advantage Plan HMO’s and PPO’s are concerned, there is no Medical Underwriting! As long as a choice is made during Annual Election, Open Enrollment, or Initial Election Period ( Going on Part B for the first time), or a qualified Special Election Period, Advantage Plans must accept you and pay claims the first day the policy is active. I don’t care if someone is going through Chemotherapy, he or she can still change plans. The only exception as of today is for those who have End Stage Renal Disease ( permanent kidney failure). However, in 2020, that exception is going away which is great news for people who have been locked into an Advantage Plan.

Now let me give an example of questions that Supplement companies may ask. Please keep in mind answering yes to one or more doesn’t necessarily mean you can’t get a Supplement. Different companies ask different questions and many only look back at two or three years of health history. This particular company I’m using as an example is concerned about some health issues that may have been treated or diagnosed as long as five years ago. Here they are:

1. Are you currently confined, or has confinement been recommended, to a bed, hospital, nursing facility, or other care facility, or do you need the assistance of a wheelchair, cane or walker for any daily activity?

2. Within the past 2 years, have you been hospitalized 2 or more times, or been confined to a nursing home for a total of 2 weeks or longer?

3. Within the past 2 years, have you been advised to have surgery ( including a biopsy), therapy, diagnostic testing, or any treatment which has not yet been done?

4. Within the past 5 years, have you consulted a medical professional, sought treatment, had treatment recommended, received treatment ( including injection therapy), been hospitalized for, or taken or been advised by a physician to take prescription drugs ( excluding drugs for high blood pressure) for the following conditions: a. Heart or vascular conditions including but not limited to heart attack, open heart surgery, placement of a stent or defibrillator, heart valve replacement, angioplasty, any aneurysm, congestive heart failure, enlarged heart, peripheral vascular disease, coronary artery disease, irregular heartbeat, stroke, or TIA? b. Alzheimer’s disease, Parkinson’s disease, senile dementia or other senility disorder, organic brain disorder any neurological disorder including spinal stenosis, any autoimmune disorder ( including but not limited to Lupus, Rheumatoid arthritis, and Multiple Sclerosis), or any anemia requiring blood transfusions? c. Any respiratory condition including but not limited to Chronic Obstructive Pulmonary Disease ( COPD), RAD ( Reactive Airway Disease), asthma, emphysema or use of inhalers, nebulizers or oxygen? d. Internal cancer, Leukemia, melanoma, Hodgkin’s disease, insulin dependent diabetes, diabetic neuropathy, Acquired Immune Deficiency Syndrome ( AIDS), AIDS- Related Complex ( ARC), chronic kidney disease, kidney/ renal failure, dialysis, cirrhosis of the liver, organ transplant ( except cornea), or amputation?

5. In the past 12 months have you had a placement of a pacemaker or had a joint replacement?

6. Within the past 2 years, have you been confined in a facility for drug or alcohol abuse or a mental/ nervous condition?

In addition to certain medical conditions being the reason for denial, most Supplement companies have lists of medications that if taken, will trigger an automatic denial.

If you have any questions regarding today’s column, give us a call or email me personally at aaron@getyourbestplan.com.