Wrong Genes May Stop You from Obtaining LTC Insurance

People today are interested in their ancestry. They use DNA testing to learn more about their family tree. However, health issues in your DNA may be used against you as you also plan for long-term care.

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Wrong Genes May Stop You from Obtaining LTC Insurance
5 Min Read September 7th, 2018 Updated:January 27th, 2020

More people are looking into their family history by using genetic testing to find out about their ancestry. Many services, like 23andMe, provide an abundance of information. They will show you your genetic make-up, including details about those people who share your genetic make-up. You will discover what regions of the world your family originated. One of the most controversial pieces of information they will provide is information about many health-related issues your genes may carry.

This information can be very interesting and helpful; however, it could eliminate you from obtaining Long-Term Care Insurance depending on the results of the test. 

What's In Your Genes?

Knowing family history and the basic traits that appear in your family history can be fun but knowing your risk for disease could be frightening for some people. Once this knowledge exists, an insurance company may use this information in determine your eligibility for coverage if you apply for Long-Term Care Insurance. 

This insurance has become a big part of retirement planning. Longevity means you may be more likely to require some form of long-term care. The financial costs and burdens that come with aging will have a significant impact on your family and finances. The possibility of long-term care has become a major concern of Generation X and Late-Boomers who are planning for their future retirements. They see first-hand how aging is impacting their parents and other elderly family members. They realize that being a family caregiver is hard, and paid care drains savings and investments as well as adversely impacting lifestyle. 

Long-Term Care Insurance is a product that pays for extended care, at home or in a facility. People require long-term care services and supports due to illnesses, accidents, or just the result of getting older — including conditions like Alzheimer’s and Parkinson’s. 

Longevity Means Advance Planning is Essential

Longevity is impacting retirement in many ways. People fear, for a good reason, that they may run out of money during their retirement. As you get older, your chance of needing help with activities of daily living or supervision due to cognitive decline increases. 

The cost of long-term care services can quickly drain savings and adversely impact income, lifestyle, and legacy. Health insurance, including Medicare and supplements, will not pay for most long-term care costs. Long-Term Care Insurance is a frequent answer to safeguard savings and income and reduce the stress otherwise placed on family members.

But what happens if an insurance company knows you are at higher risk for one of these health conditions due to your genetics?

"This is something we are very much concerned about. When we have genetic testing information we will use this information, although most of it is benign. Sometimes the information is volunteered by the applicant during the interview process. Other times the information appears in medical records. There are some genetic issues that, if we are aware of it, we will not approve the application," said an insurance company executive who requested anonymity.

The APOE e4 Gene

One example could be the APOE e4 gene. The most common variety of Alzheimer's disease usually begins after age 65 (late-onset Alzheimer's disease). This is the most common gene associated with late-onset Alzheimer's disease (called apolipoprotein E (APOE). APOE e4 appears to increase the risk of Alzheimer's. If your genetic test showed you carried this gene would your Long-Term Care Insurance application be declined? Perhaps.

23andMe, for example, offers testing which can tell you if you have several genetic risks including:

  • BRCA1/BRCA2 - Genetic risk based on a limited set of variants for breast, ovarian and other cancers
  • ARMS2 and CFH - Genetic risk for Age-Related Macular Degeneration 
  • SERPINA1 - Genetic risk for Alpha-1 Antitrypsin Deficiency a lung and liver disease
  • HFE - Genetic risk Hereditary Hemochromatosis 
  • F2 and F5 genes - Genetic risk for Hereditary Thrombophilia, harmful blood clots 
  • LRRK2 and GBA genes - Genetic risk for Parkinson's Disease

In general, Long-Term Care Insurance carriers can legally utilize genetic test results in their underwriting process for new applicants. The federal Genetic Information Nondiscrimination Act does prohibit health insurance companies from asking for or using your genetic information to make decisions about whether to sell a health insurance policy to you. Nor can they use it for how much they charge you in premium. These rules don't apply to Long-Term Care Insurance underwriting. 

You Must Health Qualify in Order to Obtain Long-Term Care Insurance

You can understand why insurance companies are concerned. The risk of an average person needing extended care is high to start with. The U.S. Department of Health and Human Services reports that if you reach the age of 65, you have a 70% chance of needing some type of long-term care service before you pass. If your risk is very high due to genetics, the risk becomes too high for an insurance company to underwrite. 

When you apply for Long-Term Care Insurance, they will generally obtain your medical records, complete a detailed health interview (usually on the phone), and review your prescription drug records. Some companies will ask questions about your family history, especially if one of your parents suffered from some form of cognitive decline. 

If your doctor ordered genetic testing, those results would appear in your medical records. 

This information is fair game. If you told your doctor about consumer genetic testing, and they wrote that information in your medical records, the insurance company will see this information and consider it as well. Don’t forget, almost everything you tell your doctor usually goes into your medical record.

If you volunteer during the interview that you had genetic testing completed, the underwriter will ask for and use that information.
This only applies if you undergo testing before obtaining coverage. If you get genetic testing after you have a policy, those results will not impact your coverage or ability to make a claim in the future.

If you are planning to protect your future retirement funds from the costs and burdens that come from getting older, you better act before your health changes. Every insurance company has their own underwriting criteria which they use to consider your application. 

If you have not yet completed genetic testing, like 23andMe, Helix, and others, you may want to consider obtaining Long-Term Care Insurance before that testing.

Experts say the best time to plan is before retirement, usually in your 40s or 50s when your health is better, and premiums are much lower. 

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About the Author

Linda is a former journalist who now enjoys writing about topics she is interested in so she “can keep her mind active and engaged”.

LTC News Contributor Linda Maxwell

Linda Maxwell

Contributor since December 11th, 2017

Editor's Note

Planning for getting older is not easy. You should consider your life expectancy, your finances, and how long-term care can derail the best plans. Think about how your future care would impact your family and finances. 

Generally, most people do not want to place the responsibility of caregiving on their family. Caregiving is tremendously stressful for loved ones and often affects their health, careers, and family relationships. 

Use the Tools Available on LTC NEWS

Start your research by finding the current and future cost of care services where you live. The LTC NEWS cost of care calculator will show you the financial impact care can have on you. Click here to use the calculator.  

You will also find any tax incentives you might qualify for and the availability of Partnership Long-Term Care plans, which provide additional dollar-for-dollar asset protection.

LTC NEWS offers many other resources for your research. Click here to find these tools. 

Use a Long-Term Care Insurance specialist to help you design an affordable plan and select the right company based on your age and health. 

The American Association for Long-Term Care Insurance, a national consumer advocacy, and education group, suggests finding a specialist with at least three to five years’ experience in Long-Term Care Insurance. The AALTCI says this specialist should have substantial experience.  They recommend that the specialist should have helped at least 100 people, although more is better. A specialist should work with multiple companies, not just one or two.

Plus, premiums can vary dramatically for the same coverage.  A specialist will match your age, health, and other factors in shopping for the best coverage at the lowest cost. Find a qualified, trusted specialist by clicking here:

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