Shopping for a Medigap Policy

Medical underwriting: During open enrollment, and with special Medigap protections, insurance companies cannot use medical underwriting or refuse to write you a policy. During other times, insurance companies can refuse to issue a Medigap policy. Medical underwriting is the process that an insurance company uses to determine whether or not to accept your application for insurance, and how much to charge you for that insurance. It usually involves answering medical questions on an application. Some insurance companies may require a review of your medical records.

Health history: Do not be misled that your medical history on an application is not important. Omitting specific medical information on your application can be very costly. If your application for individual health insurance includes questions about your health, be sure that you answer all medical questions completely and accurately. If an agent helps you fill out the application, do not sign it until you read it. If you omit medical information and the insurance company finds out about it later, the company may deny your claim and/or terminate the policy.

Since the application is part of the insurance contract, you will receive a copy with the policy. Make sure that it has not been changed and that all the medical information in the application is accurate.

Policy Delivery and Refunds: Policy delivery or refunds on policies should be made promptly by insurance companies. If you do not receive your policy within a month, or if there is a delay in receiving a refund, call or write the insurance company.

If you buy from an agent, find a good local insurance agent who can help you buy the right policy and will also assist you with making claims.

Policy Storage: Keep the policy in a safe place. It is a good idea to choose someone ahead of time who can take over your affairs in case of a serious illness. This person should know where your records are kept.

Duplicate coverage: Buy only one policy. Buying one comprehensive health policy is much better than buying several limited policies. Duplicate coverage is costly and unnecessary. This is true for both group and individual policies.

Replacing Existing Coverage: Make sure you have a good reason for switching from one policy to another. You should only replace existing coverage for different benefits, better service, or more affordable premiums.

Payment: Make checks payable only to the insurance company—do not pay cash or make a check out to the agent. Be sure you have the agent's name, address, and Wisconsin agent's license number, and the name and address of the insurance company from which you are buying the policy.

Insurance Agents and Companies: An insurance company must meet certain qualifications to do business in Wisconsin. This is for your protection. In all states, insurance companies and agents must be licensed. Agents may be required to carry proof of licensure showing their name and the insurance company they represent. If the agent cannot verify that he or she is licensed, do not buy a policy from that person. A business card is not a license. To find out if an insurance company or agent is licensed in this state, you may call toll-free 1-800-236-8517. Licensing information about agents and companies can also be found on OCI's home page in the Quick Links section under Agent/Agency Lookup (https://ociaccess.oci.wi.gov/ProducerInfo/PrdInfo.oci) and Company Lookup (https://ociaccess.oci.wi.gov/CmpInfo/CmpInfo.oci).

Do not be pressured into buying a Medigap policy. Good sales people will not rush you. If you are not certain whether a Medigap policy is what you need, ask the agent to explain it to you with a friend or family member present. Keep in mind, however, that if you are within your 6-month open enrollment period or qualify for special protections, you will have a limited time period in which to buy the Medigap policy of your choice without special conditions being imposed. Once this 6-month open enrollment or special protection period ends, the Medigap policies available to you may be limited, especially if you have a pre-existing health condition.

It is illegal for anyone to sell you a policy and call it a Medigap policy if it does not match Medigap standardization requirements. A "retainer agreement" that a doctor offers you to provide certain non-Medicare-covered services and waive the Medicare coinsurance and deductible amounts may be illegal. If a doctor refuses to see you as a Medicare patient unless you pay him or her an annual fee and sign one of these retainer agreements, you should call the Medicare hotline at 1-800-633-4227 or 1-877-486-2048 TTY/TDD for hearing and speech impaired.