Health & Financial Qualifications

LTC Insurance is considered health insurance and has medical underwriting.

Not everyone can health-qualify for long term care insurance. Those who do not qualify (or can but don't) will pay out of pocket (self-insured). They may have waited too long to insure. If you cannot health qualify then you need to make other plans.

The percentage of applicants denied increases with age:
Age % of those who apply and cannot health qualify
50-59 16%
60-69 24%
70-79 41%
Not only does the premium go up the older you are when you apply, your health might prevent you from buying this insurance at any age, meaning you'll have to find money somewhere else to pay for care. You can see why it's important to insure while young and insurable.

If you can qualify for preferred health you'll save 10%-20% on your premium, another reason to insure while you're at your healthiest. The younger you are the cheaper it is, and the less you will pay over your lifetime. (see Cost of Waiting)

The guidelines listed below are provided a guideline to determine if you might qualify but only by pre-qualifying with a quote, and in some cases only by applying for approval will insurability be certain.

  • A person should be able to perform activities of daily living such as bathing, dressing, eating and walking.
  • A person should have the ability to handle daily activities such as finances, housework, laundry and meal preparation, shopping, taking medications and transportation.
  • A person should have the ability to function without assistance from another individual or mechanical device (e.g. a walker, wheelchair, oxygen or dialysis.)
  • A person should have clarity of thought with no signs of memory loss, confusion or forgetfulness.
  • All acceptable medical conditions must be stable and well controlled. (Medical conditions should not be severe or deteriorating, e.g. anticipating surgery, medical work-up in progress or undergoing physical therapy.)

If you respond yes to any of the following you may not be eligible to apply for long term care insurance.

Have you had, do you currently have or have you ever been medically diagnosed as having any of the following:

  • AIDS
  • ALS (Lou Gehrig's Disease)
  • Alzheimer's Disease
  • Cirrhosis of the liver
  • Dementia
  • Diabetes under treatment with insulin
  • Diabetes Type II and heart problems
  • Frequent or persistent forgetfulness
  • HIV
  • Memory loss
  • Metastatic cancer (spread from original site/location)
  • Multiple sclerosis (MS)
  • Muscular dystrophy
  • Organic brain syndrome
  • Parkinson's disease
  • Senility
  • Stroke
  • Transient Ischemic Attach (TIA) within the past 5 years
  • TIA in combination with diabetes or heart surgery
  • TIA two or more times

  • Do you use a walker or wheelchair; oxygen; respirator; or kidney dialysis; or need assistance or supervision by another person performing any of the following: moving in/out of bed or chair; bathing; eating; toileting; bowel/bladder control; walking?

  • In the past 6 months have you had: open heart surgery; back or spine

For a more complete list of uninsurable conditions and uninsurable medications Click Here (pdf).

If you HAVE any of the above you might qualify for a life insurance or annuity with a long term care rider. These are often called Linked Benefit products.

If you are taking one of the medications on the list for another reason than described you should check with us if you could apply.

If you DO NOT HAVE any of the above conditions but do have health issues the only way to find out if you can get LTC insurance is to apply for it. There is no obligation to see if you qualify.

Unless you haven't seen a doctor in over 2 years normally only a health interview and medical records review is required. If it has been more than 2 years you should get a physical before applying.

Depending on the benefits you want, your health and age, a phone or in-person health interview with a nurse may be requested. We will tell you what is involved in your interview if you apply through us.

In addition to the list above LTC underwriters will look at the overall health of a person and there may be a combination of health issues that prevent underwriting. As you know a change of health can occur without any warning and once it occurs you may not be insurable.

If you have hypertension, high-blood pressure, type II diabetes, or pre-diabetic you should see if you qualify before your health changes and you become uninsurable.

It's no surprise that a number of applicants are turned down because of health issues and today more and more people are declined because of weight. Check with these two tables to see if you are insurable Build Table Non-DiabeticBuild Table Diabetic Type I and Type II (adult).

The risk that our health may change is real and it is not something we can plan for, but planning for long term care is something we can do. Are you in denial about the possibility of needing long term care at any time?

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What if You Cannot Health Qualify?

There are multiple options depending on your health and goals.

1st Option:
If you are uninsurable for the Traditional LTC plans and the Life Linked Benefit plans with full underwriting, you can consider a Annuity Linked Benefit product which may have more lenient underwriting.
2nd Option:
If you are uninsurable for the Annuity Linked Benefit plans then you may want to consider a Life Linked Benefit product that does not underwrite for the LTC benefit. Generally these plans will allow you to accelerate some portion of the death benefit to pay for LTC expenses.
Final Option:
If you are uninsurable for both Life Insurance and LTC insurance then we would recommend a plan where they could accumulate assets in a safe investment set aside specifically for LTC expenses. There are Indexed Annuities that protect principal and guarantee a stream of income for life through a Guaranteed Withdrawal Benefit and in most states the benefit will increase if you enter a nursing facility.
Already Receiving Care:
If you are already receiving care there is a plan for help pay for care in the most efficient manner. A medically underwritten single premium immediate annuity. This will provide a lifetime guaranteed stream of income with an enhanced payout because of your reduced life expectancy. These products require a single premium deposit and may free up the rest of your assets to spend as needed.

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Financial Qualifications

Not everyone qualifies financially but everyone should have a plan.

For those with no assets or are low-income they would most likely be depending on state aid (Medicaid/welfare). In most cases the most you should budget for your policy is no more than 7% of your income.

Many families are going to face the financial burden of long term care expense. In a worst-case-scenario long term care could conceivably cost up to $1Mil (10yrs at $100,000/yr). If it happened to you, where would you get the $1Mil?

For those with a lot of income and substantial assets may decide to self-insure even if care costs $500,000. (see self-insure chart)

A Fresh Look at Long Term Care
Could you afford to withdraw $250,000 from your retirement savings to pay for one year in a nursing home? - Kiplinger Financial Articles

The guidelines for determining whether or not long term care insurance is financially appropriate are partly based on your risk.

For example a 50-year old in good health with Alzheimer's disease in their family history may want to consider a "4-6 year" policy.

On the other hand a 50-year old with heart disease in their family may want a shorter "2 to 4 year" policy.

The purpose for this insurance is to protect that nest egg you've spent years building or are in the process of building. That nest egg is your income for retirement. Imagine what it would be like if you had to spend that on long term care? Refer to the Interest on Savings chart to see how insurance protects the nest egg.

The non-financial side of long term care insurance is the support you get from the care coordinator. Ask anyone who has had to do this how much is involved and how stressful it was for them (and their family).

If you or your spouse needed care, who would you call? Would you look in the yellow pages for care providers? Who would you know to trust? You've heard the horror stories about theft and abuse by care givers. Why take a chance, let a professional help. With insurance you will have care management not crisis management.

The care coordinator is not a gatekeeper, they are usually a local nurse, who knows everyone in your community that provides whatever you need for your care, be it a carpenter for home modifications, home care helpers, therapists, and others. This saves you and/or your family from setting up and managing care, which can be very stressful and time consuming.

With LTC insurance you can have care management not crisis management.

Next: Long Term Care Resources

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