What disqualifies you from long-term care insurance? This is an important question to ask, especially if you plan to buy a policy. In this guide, we’ll go over some of the things that can keep you from getting insurance coverage. Remember that each insurance company has its own set of rules, so speaking with an agent before applying for a policy is very important.
Before we proceed let’s look at what long-term care insurance is all about.
what is Long-term Care Insurance?
Long-term care (LTC) insurance is a coverage that covers nursing-home care, home health care, and personal or adult day care for people over the age of 65 or who have a chronic or disabling condition that necessitates constant supervision. LTC insurance provides more flexibility and options than many public assistance programs, such as Medicaid.
KEY LESSONS
- Long-term care insurance typically covers all or part of the cost of assisted living facilities and in-home care for people 65 and older, as well as those with a chronic condition that necessitates constant care.
- It is private insurance that is available to anyone who can afford it.
- Long-term care insurance provides more options and flexibility than Medicaid.
Long-term Care Insurance Cost
So, what is the cost of long-term care insurance? The cost of long-term care insurance can vary pretty widely.
Long-term care insurance is not cheap. According to a 2022 price index survey of leading insurers conducted by the American Association for Long-Term Care Insurance, a 55-year-old man in the United States can expect to pay a long-term care insurance premium of $2,220 per year on average (AALTCI).
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That will cover $165,000 in benefits when the policyholder takes out the insurance and $400,500 when the policyholder reaches the age of 85, assuming benefits are increased at a rate of 3% per year.
Long-term care insurance costs, on the other hand, vary greatly depending on factors such as your age, health condition, and the specific policies of your insurance carrier, such as an inflation rider. That is why it is critical to shop around for the best rates and terms. You can also consult with a financial advisor to help you plan for the future.
The AALTC provides annual premium estimates based on its 2022 study of various long-term care insurance carriers below. These calculations assume that your policy’s benefits grow at a rate of 3% per year.
See the table below:
| Annual Premium Estimates | ||
| Status | Age | Premium |
| Single Male | 55 | $2,220 |
| Single Female | 55 | $3,700 |
| Couple | 55 | $5,025 |
Note that these are only averages based on data collected from leading insurance carriers. Long-term care insurance costs can vary greatly depending on several key factors.
What Disqualifies From You From Long-term Care Insurance?
The specific factors that may disqualify someone from obtaining long-term care insurance can vary between insurance providers, but common reasons for disqualification may include pre-existing medical conditions, age, or a history of certain health conditions or impairments.
Additionally, some insurance providers may have certain requirements for an individual’s level of physical or cognitive functioning in order to qualify for coverage. It’s important to review the specific eligibility criteria and requirements of different long-term care insurance providers to determine if you meet the qualifications for coverage.
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When it comes to long-term care insurance, there’s an old adage that goes, “Your money pays for it, but your health really buys it.” This is because certain pre-existing health conditions, which we list below, can make it impossible for you to qualify for health insurance.
However, if you are in reasonably good health, now is the time to begin the process.
Is Long-Term Care Insurance Available to Everyone?
No, not everyone is eligible for long-term care insurance. Certain requirements must be met in order to qualify for coverage. Most insurance companies, for example, require that you be at least 18 years old and a U.S. citizen or legal resident. In addition, you must be in good health and have no pre-existing medical conditions.
Does Every Insurance Company Require The same Qualifications?
No, each insurance company has its own set of requirements for coverage approval. As a result, it is important to consult with an agent before applying for a policy in order to understand the requirements.
What Disqualifies From Long-Term Care Insurance
Here are long-term care insurance disqualifications:
- A major health condition, such as cancer, heart disease, or Alzheimer’s disease, will almost certainly disqualify you from long-term care insurance.
- Elderly Age: If you are considered elderly (usually over the age of 85), you may be ineligible for long-term care insurance.
- A history of substance abuse: You will not be eligible for coverage if you have a history of substance abuse. This includes alcohol, drug, and prescription medication abuse.
- Criminal record: If you have a criminal record, you may be denied long-term care insurance coverage. This is especially true if you have a felony conviction.
Who Qualifies For Long-Term Care Insurance?
Most people over the age of 65 who have a serious health condition will be eligible. However, each insurance company has its own set of criteria for determining eligibility.
Some companies, for example, may require you to have a certain amount of assets or income to qualify. Others may base their decision solely on your medical history.
It is ultimately up to the insurance company to determine who is eligible for long-term care insurance. If you believe you may require this type of coverage, make sure to research the requirements of various insurance providers in order to find one that best meets your needs.
Next Steps to Take…Long-term Care Insurance
If you are considering purchasing long-term care insurance, you should consult with an agent to determine your eligibility. Because each insurance company has its own set of rules, it is critical to obtain the most up-to-date information before applying for coverage.
Most people have some health issues… maybe little hypertension that they take medication for… Maybe you had cancer a few years ago. Even people with medical conditions may be eligible for long-term care insurance, but it is important to speak with a long-term care insurance professional who has access to multiple insurers.
Health underwriting criteria differ from one insurer to the next. They also change from time to time. So you’ll need someone with current knowledge to scout the market for you before you apply. You’ll save time this way. You have the ability to save money. You’ll also avoid being turned down.
Here’s some crucial information. Your good health can qualify you for preferred health discounts, which can save you a lot of money. You also secure their commitment. Even if your health changes in the future, you cannot lose your good health status.
The American Association for Long-Term Care Insurance recently conducted a study that revealed the percentage of applicants who qualify for good health discounts and the percentage who were declined. Starting the process at a younger age, especially in your 50s, is clearly advantageous.
The table below shows the Percentage of Applicants in 2007 Who Qualified for a Good Health Discount
| Age of Applicant | Average Who Qualify |
| Under 30 | 63.2% |
| 30 to 39 | 66.3% |
| 40 to 49 | 66.8% |
| 50 to 59 | 51.5% |
| 60 to 69 | 42.2% |
| 70 to 79 | 24.2% |
The table below shows the Percentage of Applicants who Declined Coverage (Individual Policies)
| Age of Applicant | Average Declined Coverage |
| Under 50 | 7.3% |
| 50 to 59 | 13.9% |
| 60 to 69 | 22.9% |
| 70 to 79 | 44.8% |
| 80 and Over | 69.8% |
Pre-existing conditions may make it impossible for you to qualify for health insurance. If you have any of these health issues, it is unlikely that you will benefit from requesting a quote for long-term care insurance.
Do not fill out the form if you are currently:
- Using a multi-pronged cane, crutches, oxygen, a walker, or a wheelchair.
- if you need assistance bathing, dressing, feeding, toileting, urinary or bowel continence, or transferring from your bed to a chair.
- Use or require home health care, adult day care, assisted living, or nursing home care
- Need assistance with grocery shopping, transportation, telephone use, or banking?
Do not fill out the form if you currently have the following:
- AIDS or HIV infection
- Alzheimer’s Disease
- Active Hepatitis C, Non-A, Non-B, or Autoimmune
- Amyotrophic Lateral Sclerosis (ALS)
- Cystic Fibrosis
- Dementia
- Hemophilia (other than Von Willebrand disease)
- Kidney Failure
- Liver Cirrhosis
- Memory Loss
- Mid – Advanced Multiple Sclerosis
- Muscular Dystrophy
- Paralysis
- Parkinson’s Disease
- Post-Polio Syndrome
- Schizophrenia
- Sickle Cell Anemia
- Systemic Lupus Erythematosus
Insurance Underwriting: Long-term Care Insurance
The majority of people who buy long-term care insurance are between the ages of 40 and 70. (although some companies offer coverage for both younger and older ages.). Insurance companies recognize that, as we age, we begin to develop health issues. Health issues or physical disabilities that increase a person’s risk of needing care above a certain percentage are scrutinized by insurance companies. To put it another way, you don’t have to be perfect.
Many people have high blood pressure and other heart and circulatory problems, such as high cholesterol. These are generally insurable conditions.
Long-term Care Insurance Bottom Line
If you are not insurable, we sincerely apologize. Regrettably, we speak with many people who are not medically qualified for long-term care insurance coverage. Please inform those you care about the importance of beginning a long-term care plan while they are still young and healthy.
However, if you are in relatively good health, now is the time to begin the process.
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