Medical underwriting

Medical underwriting is a process used by insurance companies to evaluate the health risks of individuals applying for insurance coverage. During underwriting, insurers assess factors such as medical history, current health status, age, lifestyle habits, and pre-existing conditions to determine the likelihood of future healthcare costs. Based on this assessment, insurers may adjust premiums, limit coverage, or deny coverage altogether. Medical underwriting is common in individual and small group health insurance markets, where insurers seek to manage risk and maintain financial stability. However, under the Affordable Care Act (ACA), insurers are prohibited from using medical underwriting to deny coverage or charge higher premiums based on pre-existing conditions in the individual and small group markets, ensuring access to affordable coverage for all individuals regardless of health status.