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Can I Get Long-Term Care Insurance with Pre-Existing Health Conditions?

Quick Answer

Very few LTC Insurance companies have pre-existing health exclusions. You need to have reasonably good health to obtain coverage. You don't need to have perfect health.
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Detailed Answer

Can you get Long-Term Care Insurance with Pre-Existing Health Conditions?

Often the answer is - yes you can.

Few of us have perfect health once we get past age 40. While a Long-Term Care Insurance company will review your health when you apply to determine if they will issue your policy, you absolutely can get LTC Insurance coverage if you have pre-existing conditions. 

Every insurance company has its own underwriting criteria, which they will follow when you apply for coverage. A Long-Term Care Insurance specialist will ask you many questions about your health and family history. This information will help them match you with the right company.

The better your health, the lower your rate - however, there are health problems that will make you uninsurable with some or all insurance companies. 

What About Pre-Existing Health Language in the Policy Itself?

Can an insurance company issue a policy but refuse to cover you if you need care for a pre-existing health problem?

Generally, the answer is no; the clear majority of insurance companies have no pre-existing language in their Long-Term Care Insurance contracts. They will either approve your application or not. 

However, a few companies may include a six-month pre-existing clause. This means if you make a claim in the first six months of a policy's existence, they could exclude benefits if it were due to a known condition. 

After six months, all pre-existing health conditions would be covered. Be sure to ask the Long-Term Care Insurance specialist about the policy you are considering.

Uninsurable Health Conditions

You need to have reasonably good health to obtain Long-Term Care Insurance coverage. You do not, however, need to have perfect health.

There are health issues that are generally uninsurable with every insurance company for traditional Long-Term Care Insurance and most asset-based-hybrid policies. 

Limited duration/short-term policies have fewer underwriting requirements; however, anyone who currently needs care would be uninsurable. 

Some of the health issues that generally would be uninsurable with both traditional and most hybrid plans include: 

  • AIDS/HIV
  • Alzheimer's Disease, dementia, and other forms of cognitive issues 
  • Ankylosing 
  • Amyotrophic Lateral Sclerosis 
  • Bipolar Disorder or other depression with the use of antipsychotic medications and Schizophrenia
  • Significant Cardiomyopathy
  • Cerebral Atrophy (Paralysis)
  • Cerebral Palsy
  • Cirrhosis of the Liver
  • Confusion
  • Current Cancer and Metastatic Cancer
  • Cushing's Syndrome
  • Cystic Fibrosis
  • Huntington's Disease
  • Kidney Disease requiring dialysis
  • Multiple Sclerosis
  • Muscular Dystrophy 
  • Myasthenia Gravis 
  • Parkinson's Disease  
  • Scleroderma
  • Spinal Cord Injury 
  • Significant Stroke/ Cerebral Vascular Accident (CVA) j j
  • Systemic Lupus

Anyone who currently receives or requires help with activities of daily living would be unacceptable, including anyone residing in or who has been advised to reside in a care facility. 

Anyone using medical devices like a wheelchair, walker, hospital bed, quad cane, crutches, or use of a stairlift would be deemed uninsurable. Any person who requires oxygen therapy would also not be eligible for coverage. 

Generally, anyone receiving disability benefits would be deemed uninsurable (although there are some limited exceptions, including military disability depending on the reason). 

Every insurance company has its own underwriting criteria. A Long-Term Care Insurance specialist can review your health history and match your age and health with the right company.

LTC Insurance Underwriting

Most people who purchase Long-Term Care Insurance are between ages 40 and 70 (although some companies offer coverage to both younger and older ages). Insurance companies understand that as we get older, we start having some health problems. Insurance companies look at health issues or physical disabilities that increase a person's risk of needing care beyond a certain percentage. In other words, you don't have to be perfect.

Many people have high blood pressure and other heart and circulatory issues, including elevated cholesterol. In most situations, these are insurable conditions.

Control and Stability

Insurance companies want good control. They expect the health issues you have to be stable. They will look at the number of medications you use and how well-controlled, and for how long. Recent health events or changes in medications may trigger "wait" periods as the companies want stability. 

Even heart attacks and heart surgery, if fully recovered, will be considered by most companies. 

Insurance companies will look at your height and weight. Don't worry; overall, the height/weight charts are relatively generous. If you have other pre-existing conditions, like diabetes, joint problems, etc., the combination of the health problem with obesity can limit insurability. 

Pain medication will always bring up a yellow flag but can be considered depending on the medication and the reason for its use. However, any current use of opioids can be very problematic.  

Recent surgeries will usually require a waiting period from three to six months in most situations. However, some benign surgeries may not require any waiting period. If you have a pending surgery, all insurance companies will want to wait until it is completed. 

Preparing for Health Questions

To obtain accurate quotes and information, you need to share all your health history with a Long-Term Care Insurance specialist - Work With a Specialist | LTC News  - for them to make the proper recommendations. Be sure your specialist represents the top companies, not just one or two. Be sure they understand underwriting rules and won't just take your information to the "back office" person. 

Unusual or significant health problems may mean the specialist will have to speak with underwriters to pre-qualify.

Be honest and share everything with your specialist. Have a list of all your medications and the reasons you are taking them. Don't be embarrassed. They need to know, and they have heard all before. 

Your information is kept confidential as required by law. 

Interviews

When you apply for coverage, you will undergo a health interview with a nurse, usually on the phone. At some ages, the insurance company will order a face-to-face interview where the nurse will visit with you in your home. Generally, they will also take your vitals and get your height and weight.

Usually, the insurance company will order a cognitive assessment for applicants over the age of 60 and some under age 60. This interview will include word recall, word association, and simple math.

Be sure to answer honestly - but only answer the specific questions they ask you. Yes or no questions are answered by saying - yes or no. Plus, no joking about memory loss. 

Avoid Misleading the Agent about Your Health

Most Long-Term Care Insurance specialists work with the major companies. Remember, each company has its own underwriting rules. When the Long-Term Care Insurance specialist asks you health questions, be sure to be completely honest. They are working for you to match you with the right company. 

If the agent does not ask you questions - or very few questions - find another agent.

The insurance company will be ordering medical records, so be sure to tell the specialist about all your health problems so they can give you accurate recommendations. 

 

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