Eligibility for Coverage

Before you even begin shopping for Long-Term Care Insurance, you need to know whether you can buy a policy and qualify medically.  Unlike health insurance post-ACA, Long Term Care policies, like life insurance, still require medical underwriting and have fairly rigorous requirements for approval. 

Every insurance company will have different guidelines for what medical conditions are acceptable to them for underwriting.  If you feel you have conditions that may be borderline insurable, call us and we can determine specifically what options you have.  

Uninsurable Conditions

Rules to QualifyMost companies may immediately disqualify your application for Long Term Care Insurance if you have any of the following conditions:

  • Alzheimers / Dementia
  • Multiple Strokes
  • Diabetes treated with 50+ units of insulin
  • Pain treated with narcotics
  • Severe Obesity
  • Disability Income
  • Multiple-occurrence of cancer or treatment ongoing

This guide is designed to be helpful as general advice, but you should contact a licensed insurance agent with your specific case before making a decision to forego insurance.  There may be higher-risk policies available from carriers for some cases that may be uninsurable with the “blue chip” companies.

Mild memory loss is an issue that affects many of us as we age.  This can be an issue for LTC insurance since cognitive impairment is a potential trigger for benefits.  Underwriting will require that extensive neurological testing be completed if you’ve experienced memory loss.  It’s not uncommon to look at blood tests for B-12 levels as well as requesting CAT scans.

Combinations to Avoid

Often conditions alone are okay, but in concert may cause problems for insurability.  For example, a history of a Transient Ischema Attack (TIA) is acceptable with multiple companies, but not if any tobacco usage has occured in the past 12 months.

Similarly, having diabetes is okay but when combined with many complications like peripheral neuropathy can close the door on your ability to buy coverage.

An Expert Agent Is Important

Especially for health that may be considered marginal, having an experienced agent with the skill to navigate multiple companies can be a tremendous asset and make the difference between getting covered and getting declined.  As a recent example, one couple was encouraged by their LTC Tree agent to apply with two companies simultaneously, “just in case” with a backup application.  The advice turned out to be good - the husband was approved with one carrier but not the other; the wife was approved with the other carrier but not the husband’s company.  In the end the couple was able to both get covered, through different companies.  The world of LTC can be complex, so get multiple agents’ opinions when undertaking the serious decision of which company or companies to apply for.

Supplemental Information

Additional information on Eligibility for Coverage.

"I was concerned I may not qualify due to some arthritis treated by medications. Once I spoke with LTC Tree, I felt like I had a plan of companies that would accept me. Two months later, my application was approved and after a short Q&A with my agent I sent in the premium and put coverage in force. All is well.

Don B., Ft Myers Florida

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