Medicare Supplement Pre-existing Conditions: Carrier-by-Carrier Underwriting Guide 2025

Understanding how each major carrier handles medical underwriting can save you thousands and prevent coverage denials

🎯 Key Takeaways

  • • AARP/UnitedHealthcare: Most lenient underwriting, simplified health questions
  • • Mutual of Omaha: Strictest underwriting, detailed medical history required
  • • Blue Cross plans: Vary significantly by state, generally moderate standards
  • • Guaranteed Issue Rights: No medical questions during specific periods
  • • Best Strategy: Apply during Open Enrollment Period (no underwriting required)

Understanding Medicare Supplement Medical Underwriting

When Underwriting Applies

  • • Outside your 6-month Open Enrollment Period
  • • Switching from Medicare Advantage to Supplement
  • • Moving between different Supplement plans
  • • Applying after losing other coverage (without guaranteed issue rights)

No Underwriting Required

  • • During 6-month Open Enrollment Period
  • • With guaranteed issue rights (trial rights)
  • • Moving from Plan F to Plan G (in many states)
  • • Certain employer plan terminations

Carrier-by-Carrier Underwriting Standards

AARP/UnitedHealthcare (NAIC: 70106, 94271)

Market Leader - Most Lenient Standards

Underwriting Approach

  • • Simplified 12-question health application
  • • Focus on recent hospitalizations (past 2 years)
  • • Less emphasis on chronic conditions if stable
  • • Quick approval process (7-14 days)

Common Approval Conditions

  • • Well-controlled diabetes
  • • Stable heart conditions (no recent events)
  • • Arthritis and joint replacements
  • • Many cancers after 2-3 year waiting period

Best For: Applicants with multiple chronic conditions or complex medical histories.

Mutual of Omaha (NAIC: 71412)

Strictest Standards - Detailed Medical Review

Underwriting Approach

  • • 28-question comprehensive health application
  • • Requires detailed prescription medication list
  • • Medical records often requested
  • • Longer approval process (2-4 weeks)

Strict Declination Criteria

  • • Recent hospitalizations (past 12 months)
  • • Uncontrolled diabetes (HbA1c > 8.0)
  • • Any heart procedure in past 2 years
  • • Most cancers under 5-year waiting period

Best For: Healthy applicants with minimal medical history seeking competitive rates.

Blue Cross Blue Shield Plans

Varies by State - Moderate to Strict Standards

Lenient States

Florida, Texas, Illinois

  • • 15-question application
  • • Focus on major conditions only

Moderate States

California, New York, Pennsylvania

  • • 20-question application
  • • Prescription drug review

Strict States

Michigan, Ohio, North Carolina

  • • 25+ question application
  • • Medical records often required

Strategy: Research your specific state's Blue Cross underwriting standards before applying.

Humana (NAIC: 94183, 73288)

Moderate Standards - Technology-Driven Process

Underwriting Features

  • • 18-question digital application
  • • Automated approval for many conditions
  • • Real-time decision engine
  • • Moderate waiting periods for serious conditions

Competitive Advantages

  • • Accepts well-managed chronic conditions
  • • Shorter cancer waiting periods (2-3 years)
  • • Lenient on mental health conditions
  • • Good approval rate for seniors over 75

AFLAC (NAIC: 13412)

Niche Player - Moderate to Lenient Standards

Underwriting Approach

  • • 16-question simplified application
  • • Focus on recent medical events (past 18 months)
  • • Competitive rates for approved applicants
  • • Limited availability (select states only)

Unique Considerations

  • • More lenient on diabetes than most carriers
  • • Accepts many heart conditions if stable
  • • Good option for applicants declined elsewhere
  • • Limited agent network

Pre-existing Conditions: Approval Likelihood by Carrier

Condition AARP/UHC Mutual Omaha Blue Cross Humana AFLAC
Type 2 Diabetes (controlled) ✓ Good ~ Moderate ~ Varies ✓ Good ✓ Good
Heart Disease (stable) ~ Moderate ✗ Difficult ~ Varies ~ Moderate ✓ Good
Cancer (2+ years remission) ✓ Good ✗ Difficult ~ Varies ~ Moderate ~ Moderate
Arthritis/Joint Replacement ✓ Good ✓ Good ✓ Good ✓ Good ✓ Good
High Blood Pressure (controlled) ✓ Good ✓ Good ✓ Good ✓ Good ✓ Good
COPD (mild to moderate) ~ Moderate ✗ Difficult ~ Varies ~ Moderate ~ Moderate
Mental Health Conditions ✓ Good ~ Moderate ~ Varies ✓ Good ✓ Good

Strategic Application Tips

For Healthy Applicants

  • • Shop rates first: Mutual of Omaha often has lowest premiums
  • • Apply during Open Enrollment: No medical questions
  • • Consider Plan G: Best long-term value for most people
  • • Multiple applications: Apply to 2-3 carriers simultaneously

For Complex Medical History

  • • Start with AARP/UHC: Highest approval rate
  • • Work with an agent: They know carrier preferences
  • • Prepare documentation: Recent lab results, specialist notes
  • • Consider Plan N: Lower premiums, easier approval

If Declined by Multiple Carriers

  • • Wait for guaranteed issue rights: Loss of other coverage
  • • Consider Medicare Advantage: No medical underwriting
  • • Check state programs: Some states have high-risk pools
  • • Reapply annually: Health conditions may improve

Documentation Tips

  • • Be completely honest: Fraud can void your policy
  • • Gather recent records: Lab results from past 6 months
  • • Get physician statements: Confirming stable conditions
  • • List medications accurately: Include dosages and frequencies

State-Specific Underwriting Variations

States with Additional Protections

Birthday Rule States

Allow plan changes within 30 days of birthday:

  • • California
  • • Illinois
  • • Idaho
  • • Nevada

Guaranteed Issue States

No medical underwriting ever required:

  • • Connecticut (Plans A, B, C, F, G, N)
  • • Maine (Plans A, F, G, N only)
  • • Massachusetts (community rating)
  • • Minnesota (community rating)
  • • New York (community rating)
  • • Vermont (Plans A, B, C, F, G, N)
  • • Wisconsin (community rating)

Ready to Apply for Medicare Supplement Insurance?

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Expert Recommendations

For First-Time Applicants

Apply during your 6-month Open Enrollment Period starting the month you turn 65 and enroll in Medicare Part B. No medical questions asked.

For Medicare Advantage Switchers

Start with AARP/UnitedHealthcare for the best approval odds. Apply in November for January coverage to maximize guaranteed issue opportunities.

For Plan Switchers

Research your state's birthday rule or other guaranteed issue rights. Some states allow annual plan changes without medical underwriting.