Do I Have to Worry About Pre-Existing Conditions?

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 would exclude benefits if it were due to a condition known prior. 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.

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

Uninsurable Health Conditions

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: 

  • 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.

Common Insurable Conditions

Most people who purchase Long-Term Care Insurance are between ages 40 and 70. 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.

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. 


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