Your health and age are the biggest factors in determining if you qualify for long-term care insurance (LTCI). Compromised health is a reason many people don’t qualify, but other important factors are that they are applying at the wrong time or with the wrong company based on their health and age.

Insurance companies look at health issues that increase a person’s risk of needing care. They won’t blindly take a risk, so they require medical underwriting.

Health

How healthy do you need to be to qualify for long-term care insurance? You don’t need to be in perfect health, but you do need to have reasonably good health.

Insurance companies want to see that your health issues are stable. They look at what medications you take, how many you take, how long you’ve taken them, and if these meds are keeping your condition under control.

If you’ve recently had changes in your medications, a recent health event or surgery, or you have a pending surgery or test results, insurance companies will want to wait until it’s completed or until test results are back.

Overall, the insurance company wants to see stability.

Common Insurable Conditions

  • Arthritis
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Heart surgery (if fully recovered)

If you have health conditions, that doesn’t mean you are disqualified from LTCI.

Your height and weight is reviewed. If you are overweight and you have other pre-existing conditions, like diabetes or arthritis, the combination of the health problem with obesity can limit how much you can qualify for, but it won’t necessarily disqualify you.

Pain medications can be considered depending on the medication and the reason for its use.

Traditional plans are the hardest to health qualify for. Hybrid plans are easier to health qualify for than traditional.

Common Uninsurable Conditions

  • Activity of Daily Living deficits (if you need help with transferring, toileting, bathing, dressing, eating, continence)
  • Alcoholism (active)
  • Alzheimer’s/Dementia
  • Amyotrophic Lateral Sclerosis (ALS)
  • Balance disorder/Gait impairment
  • Cerebral palsy
  • Cirrhosis
  • Depression (severe or hospitalized in the last 5 years)
  • Down syndrome
  • Drug addiction/illicit drug use (within last ten years)
  • HIV positive
  • Huntington’s disease
  • Macular degeneration (progressive/wet)
  • Memory loss
  • Mental retardation
  • Multiple myeloma
  • Multiple sclerosis (MS)
  • Muscular dystrophy
  • Organ transplant (except kidney)
  • Organic brain syndrome
  • Osteoporosis with compression fracture
  • Paralysis (paraplegia/quadriplegia)
  • Parkinson’s disease
  • Pregnancy (current)
  • Stroke (multiple or residual effects)
  • Surgery pending (will review after)
  • Ventricular tachycardia

Age

Many companies require you to be at least 30 years old, while one company has a minimum age of 18. The maximum applicant age is 85, but most companies max out between ages 70 and 80.

The Bottom Line

Long-term care insurance requires medical underwriting. If you have health conditions or complications, it doesn’t mean that you’ll be disqualified from coverage. You need to make sure you’re applying with a company that will most likely accept your conditions and apply at the right time.

That’s why it’s important to work with a Specialist who pre-screens your health and medical history up front before putting in an application with an insurance company. Kelly is a Certified Long-Term Care Insurance Specialist and works with the best insurance companies who offer long-term care insurance plans. She will let you know which companies will consider you for coverage and find the right plan for you.