Having a pre-existing condition can impact your ability to get Long-Term Care Insurance. But not all pre-existing conditions are equal in the eyes of an insurance company. In this article, we want to help you understand when a pre-existing condition might prevent you from qualifying for coverage. We also want to discuss conditions that are often covered. You can click here to learn more.
Few of us have perfect health once we get past age 40. So when we find out that our ability to get Long-Term Care Insurance depends on our health, we may begin to panic.
Insurance companies understand this. Luckily, you can get Long-Term Care Insurance even if you have pre-existing conditions. In many cases, your ability to qualify for coverage depends on how your condition affects you or how stable it is – more on that later.
LTC News works with Long-Term Care Insurance specialists to provide accurate long-term care information. We believe learning about long-term care options is key to managing care in the future.
Today, we’ll answer the question of whether you can get Long-Term Care Insurance with pre-existing conditions. We’ll explain situations when you would and wouldn’t be likely to get coverage. We’ll also discuss how your health can impact different aspects of your policy.
Yes, you can get Long-Term Care Insurance with pre-existing conditions. However, some conditions may be uninsurable or raise your cost of coverage, but for the most part, many stable pre-existing health conditions are insurable.
Insurance companies understand that as we age, our health declines. You don’t have to be young and in shape to get coverage, although the younger you are, the easier it will be to get a new policy. So, what exactly do insurance companies consider when you’re applying for Long-Term Care Insurance?
When you apply for Long-Term Care Insurance, companies want to know how risky you are to insure. Companies use a practice called underwriting to determine your risk.
Applicants must meet the company’s underwriting guidelines to qualify for a new Long-Term Care Insurance policy. You can read our article that explains underwriting if you want to learn more.
In this section, we’ll explain what underwriting guidelines focus on and other factors companies evaluate to determine if you qualify for a new policy. We’ll also discuss a few situations or conditions that are insurable for most companies.
Your ability to qualify for a new policy depends largely on how stable your pre-existing condition is. A stable condition is one that is manageable or controllable. Stability is also concerned with how this condition affects your daily life and how it reacts to treatment.
Stable conditions are usually controlled with medication. Companies will look at the number of medications you use and how well they control your condition.
They’ll also consider how long these medications have helped control your condition. Any recent health events or changes in medications may trigger a “wait” period for the company to assess and ensure stability.
Wait periods can last anywhere from three months to five years. However, most conditions require three to six months of stabilization.
Companies will assess any current or past pre-existing conditions. This can range from anything like high blood pressure to heart surgeries to joint pain. In many cases, stable conditions are insurable.
For example, even serious past conditions like a heart attack or heart surgery are insurable if the individual has fully recovered since the event.
Most recent surgeries require a waiting period of three to six months. However, some minor surgeries may not require any waiting period. If you have a pending surgery, all companies will want to wait until the surgery is complete before issuing a policy.
The use of pain medication is a yellow flag to companies, but many companies will evaluate the individual depending on the specific medication and its reason for use.
However, that yellow flag can quickly turn into a red flag if opioids are in use.
Companies will also consider your height and weight in your application. Most companies have relatively generous standards.
The combination of pre-existing conditions paired with obesity may cause insurability problems. Other conditions like diabetes or joint pain may be evaluated on a case-by-case basis but may impact insurability.
As we all know, life tends to get harder as we grow older. Insurance companies are aware of this. As a result, many companies have a cut-off age. This is an age where companies generally won't consider new applicants.
The cut-off age can vary by company, but many companies pick an age between 75 and 79. At these high ages, many new applicants have or will have health issues in the near future. Companies see this as high risk, so most companies won't insure these older individuals.
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). You can read this article on the best time to apply for Long-Term Care Insurance if you'd like to learn more about age requirements when applying.
Even though traditional policies will not cover individuals in their 80s, alternative insurance policies may be more flexible. For example, short-term insurance policies generally consider individuals in their 80s, depending on their health. Some hybrid Long-Term Care Insurance plans may consider older applicants as well.
Your ability to meet the company’s health and age criteria will impact:
Your ability to qualify for coverage.
How much you’ll pay for that coverage.
The available benefits within your policy.
Below, we’ll explain how companies determine your premium and available benefits based on your health.
Applicants who meet certain health guidelines are sorted into rate classes. A rate class is a rating or a grade that represents your potential risk to the company. Your rate class will also determine your insurance premium rate.
There are three main rate classes, although these titles vary by company:
Preferred – This is the highest and best rate class. Applicants in this class usually have ideal health. They pose the lowest risk for companies to insure and often pay discounted rates.
Standard – This is the average or standard rate class. Applicants in this class often have stable pre-existing conditions or past health concerns; however, they are usually relatively healthy overall. These applicants pay a standard rate.
Sub-Standard – This rate class is for individuals with several comorbid health conditions. Not every company offers this rate class. Applicants in this class may have specific conditions or combinations of conditions that prevent them from qualifying for the standard rate class. They pose the most risk to insurance companies, pay higher premiums, and may have limited benefit options.
It’s difficult to know what rate class you’ll fall into before you apply, but a Long-Term Care Insurance specialist may be able to give you a better idea of where you stand. If you’re concerned about qualifying for coverage, you should meet with a Long-Term Care Insurance specialist to learn more about your options.
Some applicants (usually those with substandard rate classes) may have limited available benefits. This is an option insurers use to try and mitigate risk.
There are a few ways companies can limit Long-Term Care Insurance benefits. The most common ways are:
The total amount of benefits within the policy is how much total money is in a policy to pay for care. A company could limit this amount, meaning the insured individual would not be able to apply for more benefits even if they wished.
Someone in a standard or preferred rate class would be able to apply for any amount of benefits allowed within the policy. However, some companies may limit the maximum based on family history without impacting the rate category.
The daily or monthly benefit amount is how much a policy will pay daily or monthly towards care. A company could limit this to a specific amount, meaning the individual would only get the predetermined amount each month and would not be able to increase their monthly or daily limit.
In contrast, someone in a preferred or standard rate class could choose a higher monthly benefit amount without restrictions.
Individuals with too many health issues may not qualify for coverage at all. In the next section, we'll cover some conditions that may disqualify individuals from getting coverage.
Some pre-existing conditions can disqualify you from getting Long-Term Care Insurance. There are two ways you may be disqualified from coverage:
You have a specific uninsurable condition.
You have an unstable condition or a combination of unstable conditions.
So when does an unstable condition turn into an uninsurable condition? Unfortunately, the answer to that question lies with the specific company you apply for. A specialist can provide clarity for your concerns.
Long-Term Care Insurance is full of gray areas. Every individual's health and situation is vastly different and unique, just as every insurance company's insurability guidelines vary greatly from one company to the next.
Severe or multiple unstable conditions usually disqualify you from starting a new policy. An unstable condition that creates a need for long-term care disqualifies you from Long-Term Care Insurance as well.
No company will sell you a policy if you already meet the benefit triggers, which are needing help with two or more activities of daily living or supervision for cognitive decline.
You cannot obtain a new policy if you are already in a care facility or receiving regular home care for your needs. This also applies if a qualified health professional advises you to seek long-term care services or facilities for regular care.
There are several conditions that many companies refuse to insure at all. We’ve put together a list of health concerns that disqualify you from most companies offering traditional and hybrid Long-Term Care Insurance policies:
AIDS/HIV
Alzheimer's Disease, dementia, and other forms of cognitive issues
Ankylosing
Amyotrophic Lateral Sclerosis
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
Schizophrenia
Scleroderma
Significant Cardiomyopathy
Spinal Cord Injury
Significant Stroke or Cerebral Vascular Accident (CVA)
Systemic Lupus
Keep in mind this is not a complete list, and, again, specific uninsurable conditions will vary by company and situation.
It's clear pre-existing conditions can disqualify you from new coverage. But what happens if you already have Long-Term Care Insurance? Can pre-existing conditions prevent you from getting care if you already have a policy?
No, generally, a pre-existing condition will not prevent you from receiving care if you already have a policy as long as you have benefits available to cover it.
No tax-qualified Long-Term Care Insurance policies have pre-existing condition language in their contracts. That means companies are obligated to cover you even if they were aware of your condition prior to issuing the policy.
However, a few companies may include a six-month pre-existing condition clause. This means if you make a claim in the first six months of a policy's existence, they could exclude benefits if you needed care for a known condition.
After six months, all pre-existing health conditions would be covered. A Long-Term Care Insurance specialist can help you determine if your policy has a six-month pre-existing condition clause.
There are specific situations where the normal rules don't apply. For example, if you lied about your health and were approved for coverage because of the lie, the insurance company could cancel your policy. (Although this is difficult to prove and generally limited within the first two years of a policy.)
However, you're unlikely to get away with a lie because Long-Term Care Insurance is medically underwritten. That means insurance companies can access your medical records when approving you for a policy. They'll find out about any health problems, whether you disclosed those issues or not.
Outside of pre-existing health condition clauses, it is illegal for LTC Insurance companies to refuse you coverage if you already have a policy.
In Long-Term Care Insurance, it is also illegal to practice post-claim underwriting. Post-claim underwriting is when a company re-evaluates a policyholder after they've filed a claim.
Because of strict regulations and protections, post-claim underwriting can never happen in any tax-qualified Long-Term Care Insurance policy meeting federal guidelines. You can read our article about Long-Term Care Insurance regulations to learn more.
Work With a Trusted Specialist
A Long-Term Care Insurance specialist can help determine your eligibility for a new LTC Insurance policy. They can also recommend a company most likely to approve your application.
When you meet with an LTC Insurance specialist, they'll ask you several questions about your and your close family's health. These questions can give the specialist a sense of whether you're insurable.
Specialists are aware of each company's rules and underwriting guidelines. That means they can help you apply for the company most likely to insure you.
It would be best to answer all questions honestly, as your information is key for a specialist's recommendations. All information disclosed to a specialist is confidential.
If an agent or specialist doesn't ask you questions or asks very few questions, you should find a new professional to work with. Specialists need to ask questions to find the best company for you to apply to.
Agents who don't ask these questions may not have the expertise you're looking for when getting a new policy. It's also essential to ensure your agent or specialist represents several top companies, not just one or two. This will give you the most choice of companies to apply to.
Remaining honest throughout the entire LTC Insurance application process is essential. Companies will find out about any discrepancies when they receive your medical records.
Pre-existing conditions can affect your ability to get Long-Term Care Insurance in many ways. It can impact your ability to qualify for coverage, how much coverage will cost, and the benefits available within your policy.
Generally, the better your health, the lower your premium and the more benefits you'll qualify for. However, companies don't expect you to have perfect health. Companies insure many applicants with pre-existing conditions.
The key to being insurable is to have a stable condition. In other words, your condition must be predictable, low-risk, and easily managed with medicine or treatment.
Unstable conditions can disqualify individuals from Long-Term Care Insurance. Some specific conditions may be uninsurable, like dementia, Parkinson's, or serious mental illnesses. Additionally, anyone who currently needs long-term care will not qualify for a new policy.
Each company has its own way of evaluating new applicants. Some companies may have more lenient health guidelines than others. That's why working with a specialist can help you apply for the company most likely to cover your pre-existing conditions.
LTC News works hard to help individuals learn about and plan for Long-Term Care Insurance and long-term care. If you found this information helpful, you may want to read our other articles:
How To Apply For Long-Term Care Insurance? – This article demystifies the Long-Term Care Insurance application process. We’ll break down the application process and give you some tips for success. We’ll also cover what you can do if your application is declined.
Long-Term Care Insurance Applications: Can I Lie About My Health and Get Away With It? – It’s very important to be truthful on your Long-Term Care Insurance application. This article discusses what happens when you lie on your application and why it isn’t a good idea if you’re hoping to get coverage.
Long-Term Care Insurance Specialists vs. Financial Advisors (Pros & Cons) – Working with a Long-Term Care Insurance specialist can do wonders for your insurance situation. But how does working with a specialist differ from working with a financial advisor? In this article, we’ll discuss the pros and cons of consulting each of these professionals on Long-Term Care Insurance.
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