If asked detailed health questions, STOP!

When finished with this page, go back to Enrollment Tips & Traps 

If you are losing your HPInc or HPE group Medicare plan this year due to the change to open-market individual Medicare plans,
and you want to buy a Medigap plan,
and an insurance sales agent insists on you answering detailed health questions beyond "Are you disabled?" and "Do you use tobacco?"
...stop the application process immediately!

You are undergoing "medical underwriting" -- which should not happen in your case.

If an employer group health plan (including retiree or COBRA coverage) is ending, you have a "guaranteed issue" right -- i.e. without consideration of your current health ("medical underwriting") -- in every state. (Laws in certain states require guaranteed issue in other situations.)

The agent checked the wrong box somewhere in the enrollment process.

When applying for a health policy -- anywhere -- some innocuous-sounding questions can be critical.

Examples of problematic questions:

- “Within the past 12 months, have you been advised by a medical professional to have treatment, further evaluation, diagnostic testing, or surgery that has not been performed or do you have pending test results?”"

- "Do you have difficulty performing activities of daily living?"

- Hospitalization within a specific time frame (e.g., three or more times within the past two years)

Many common conditions, including:

- Diabetes with no complications.

- High blood pressure.

Typical wording on an application: “if you answer YES to any question, you are not eligible for coverage.”

[Detailed list of medical conditions and prescription drugs given on policy applications from major Medigap insurers as reasons for medical underwriting or coverage denial. "Medigap May Be Elusive for Medicare Beneficiaries with Pre-Existing Conditions" https://www.kff.org/medicare/medigap-may-be-elusive-for-medicare-beneficiaries-with-pre-existing-conditions  Scroll down to Table 2. From KFF, the nonprofit health policy research organization.]

This recently happened to one member using Alight. We escalated their specific case to our executive contact at Alight. (Using this procedure: https://www.hpalumni.org/escalate-ARHS )

An independent insurance agent or broker -- perhaps paid a fee by you -- may be more skillful in a constructing plan application that gets approved.

1. Why this may matter to you.

You have a one-time opportunity to select or change your Medicare strategy -- if you are converting from an HPInc or HPE private group Medicare plan to an open-market individual plan.

2. How to get a Medigap plan if you are losing a group plan for 2026.

You may need to provide a "loss-of-coverage" or "disenrollment" letter from your previous health plan. (Details: https://www.hpalumni.org/enroll-loss-coverage-letter )

Examples for specific insurers.

UHC:

The wording of the loss-of-coverage letter from UnitedHealthcare is rather abrupt, but is carefully worded in Medicare language: "We’re writing to let you know that HP chose to end your medical and prescription drug coverage because you no longer meet the eligibility requirements."

Members report that if your existing group policy is at UHC -- and you are purchasing an individual open-market policy from UHC -- you do not need to forward the letter from UHC about your disenrollment from the UHC group plan. Apparently UHC's system is smart enough to deal with that.

Mutual Of Omaha:

The application process on the MoO site displays this page: https://www.hpalumni.org/MoO-GuaranteedIssue.png

The page asks "Are you applying during a Guarantee Issue Period?"

If you check "Yes" -- it asks: "Do you have one of the following plans, and that plan is ending? ...an employer Group Health Plan (including a retiree or COBRA Coverage plan)..."

If you check "Yes"-- it says:

"If your group health plan is ending through no action of your own you'll always qualify. In your state, you're NOT eligible if you're disenrolling voluntarily."

and "Good news, it looks like you are eligible for a guarantee issue period!"

and then gives instructions on how to upload your documentation.

If you have lost an HPInc or HPE group Medicare plan, and an insurance sales agent insists on you answering detailed health questions -- stop the application process immediately.

They have checked the wrong box somewhere in the enrollment process. They need to indicate that your employer group health plan has ended.

Quote the information below from the official Medicare site.

If the application is not restarted with the correct information for your case. Stop! Ask them to escalate your call.

You can ask to switch agents. (And the HPAA has an escalation path to AlightRHS management: https://www.hpalumni.org/escalate-ARHS )

Here are the rules on the official Medicare site.

Go to: https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy

Then click the "What are guaranteed issue rights?" link to see this pop-up: https://www.hpalumni.org/Medicare-GuaranteedIssue.png

The pop-up page says...

Link to this page: https://www.hpalumni.org/enroll-guaranteed-issue

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