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Underwriting or medical underwriting is process that insurance companies routinely used prior to 2014 — particularly in the individual insurance market — to determine if an applicant was an acceptable risk, and if so, how much to charge in premiums based on the applicant’s medical history. Since 2014, under new rules laid out in the Affordable Care Act, all new individual major medical plans are guaranteed issue, which means that medical underwriting is no longer allowed. Premium still vary in most states based on age and tobacco use.
Medical underwriting is still used on some policies, including short-term plans, fixed-indemnity plans, limited benefit plans, and other types of coverage that aren’t regulated by the ACA. Medical underwriting is also used by Medicare supplement (Medigap) plans if you enroll after your initial enrollment window passes.