Health Qualifications
Medical underwriting is frequently updated to accommodate changes in health & medicine.
Not everyone can health qualify for long term care insurance. About 20% of the people who inquire about long term care insurance cannot health qualify. They may have waited to long. If you cannot qualify then you need to make other plans.
The guidelines listed below are provided to help you determine if you might qualify:
- 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:
- 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
- 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 surgery?
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 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-Diabetic — Build 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?
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).
Many people are going to face the financial burden of long term care expense. This could conceivably cost up to $1Mil (10yrs at $100,000/yr). If it happened to you, where would you get the $1Mil? (See Million Dollar Problem)
For those with a lot of income and assets may decide to self-insure even if care costs $500,000 - compared to $50,000 for lifetime LTC insurance. On the other hand if you were to ask them to invest $50,000 with an almost 50/50 chance of getting $500,000 back they would do it in an instant. (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 the benefits you want, your income/assets, income, health history, and family history.
For example a 50-year old in good health with Alzheimer's disease in their family may want to consider they may need care later in life for 4-10 years. A "4-6 year" policy may be a good idea.
On the other hand say a 50-year old with heart disease in their family may want a shorter "2 to 4 year" policy because even if they only needed a couple years of care it could cost their family $100,000-$200,000.
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 insurance you can have care management not crisis management. |
Next: Long Term Care Resources 