If you apply for a Medicare Supplement (or “Medigap”) plan after your guaranteed enrollment window, the insurance company can review your health history. An important part of that review is called the “look-back” period. Below, this Supplemental insurance agency in Northwest Indiana is going to explain exactly what that means.

What is the look-back period?

Once you are past your first six months of Medigap eligibility, insurance companies are allowed to check your health background. They use the look-back period to see if you have any pre-existing conditions.

They can legally delay coverage for these conditions for up to six months. But if you have had prior continuous creditable coverage, that waiting time can be shorter or skipped altogether. For example, if you had at least six months of continuous coverage before applying, the insurance company must cover your pre-existing conditions immediately.

Outside the enrollment window, you will be subject to medical underwriting. This is when insurance companies can ask if you have had surgery, hospital stays, chronic conditions, or use certain medications. Based on your answers, they can approve or deny your application, raise your premiums, or exclude specific conditions.

How long is the look-back period?

Most insurance companies look at the past two years of your health history. The questions they ask can be different, but two years is the industry standard.

Some companies can go back further, especially if they see signs of serious illness or ongoing problems. For example, if you have had cancer, surgery, or hospital stays, they might review the last five years.

An experienced Supplemental insurance agency in Northwest Indiana can explain the specific look-back criteria used by different companies in your area.

What kind of health information is reviewed?

When you apply outside the open enrollment period, the insurance company does a thorough evaluation. You will answer health questions, and they may ask for records to verify your answers.

They might ask about past diagnoses, mental health, prescriptions, surgeries, hospital visits, and even your height and weight.

Some companies check your medical records or pharmacy history. Others may request an attending physician statement, or APS. This is a report from your doctor that gives more details about your medical history.

Insurance companies are not only looking at your past health issues. They also want to see if your current health is stable, like how well you are managing a condition or if you are still on treatment.

Having a health issue does not always mean you will be denied. Some insurance companies are stricter than others. If your condition is under control, you may still qualify.

Can you be denied based on the look-back?

If you apply after your enrollment window and don’t have guaranteed issue rights, the insurance company can deny you based on your health. They might also increase your monthly premium or delay coverage for some conditions. People with serious pre-existing conditions, like cancer or advanced diabetes, may not get approved unless they are in a protected period.

The underwriting criteria can vary based on the insurance company’s policies and your personal history. As such, it’s typically best to consult with an experienced Supplemental insurance agency in Northwest Indiana. They can help you understand which companies are more lenient with their criteria.

What should you do if you are outside the open enrollment window?

Even if you have missed your six-month Medigap enrollment period, you can still apply. But you may have fewer choices, and some plans might cost more.

You could also qualify for guaranteed issue rights. With these rights, you can buy a plan without medical underwriting in certain situations, like if you lose employer coverage or move out of your plan’s area.

So it is not too late, but the process might be harder depending on your health.

Before applying, be sure to collect your medical records. That includes any diagnoses, treatments, prescriptions, and hospital visits.

Also be careful about when you apply. If you have just finished a major treatment, you should wait until you have had more time to recover. That could improve your chances of getting approved or avoiding exclusions.

Looking for a Supplemental Insurance Agency in Northwest Indiana?

If you are looking for a Supplemental insurance agency in Northwest Indiana that can help you understand your options, Senior Care Insurance Services is here for you. We work with top-rated Medigap insurance companies and know how each one handles underwriting and look-back periods. Contact us today to schedule an appointment with our agents.