Medigap Insurers Use Pharmacy Records to Verify Health Information
Medicare Supplement (Medigap) insurers are increasingly using pharmacy databases like Milliman IntelliScript to verify applicants' health information, which can lead to application denials if discrepancies arise. This practice means that even honest mistakes or forgotten prescriptions—such as a past blood thinner prescription—can result in coverage rejections. The federal Medigap open-enrollment period is only six months long; missing it subjects Medicare Advantage members to full medical underwriting when switching plans, increasing the risk of denial. Applicants can request an IntelliScript consumer disclosure before applying to identify errors and prepare supporting documentation. This allows them to select a carrier whose guidelines align with their health history. The use of pharmacy records highlights how insurers are moving away from relying solely on self-reported information during underwriting processes, making it more critical for applicants to be thorough in reviewing their medical histories. The article also emphasizes the importance of understanding when one's six-month enrollment window begins—typically starting once someone is 65 and enrolled in Medicare Part B. Outside this period, coverage decisions may hinge on detailed health data from external sources like pharmacy records.
Topics: health insurance medical underwriting medicare advantage pharmacy records