Long-Term Care insurance (LTCI) isn’t just bought with your money, it’s bought with your health. Not everyone will be approved for LTC coverage due to health issues or co-morbid conditions that insurance carriers often decline.
When you apply for long-term care coverage, your application goes through medical underwriting to determine your eligibility for coverage. During this process, your medical records are requested by the insurance company and reviewed by experienced underwriters. If they discover a certain diagnosis, medication, or complicating health factors in your records, or from your phone health interview or face-to-face interview, your application could be declined.
“We can help you shop the market to find the best fit for your situation or advise you of other options available.”
At LTC Consumer, we’re experienced in understanding the various reasons carriers may decline individuals, which is why we discuss medical history with our clients beforehand. What one carrier may consider as a decline, another carrier may approve.
If you’re wondering if you can be approved for coverage, work with an LTC specialist to review your medical history and any current medications. We can help you shop the market to find the best fit for your situation or advise you of other options available.
Common Declines for LTCI Coverage
The most common reasons for an automatic decline for LTCI coverage include:
- Needing assistance with bathing, eating, dressing, transferring to a bed or chair, toileting, or continence.
- Currently receiving home care, adult date care, nursing home, or facility care services.
- Use of a walker, wheelchair, quad cane, motorized scooter, nebulizer, ventilator, hospital bed, oxygen, or kidney dialysis.
- Current use of narcotic pain medication
- Currently in physical therapy
- Receiving disability benefits
Other common medical diagnoses which result in a decline of coverage include:
- AIDS/HIV+
- Alzheimer’s/dementia
- Amputation due to disease
- Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease)
- Cancer of the bone, brain esophagus, liver, pancreas, or stomach
- Cirrhosis of the liver
- Congestive Heart Failure (CHF)
- Cystic Fibrosis
- Frequent/persistent forgetfulness or memory loss
- Huntington’s Chorea
- Chronic kidney disease
- Metastatic cancer (spread from the original site)
- Multiple Sclerosis (MS)
- Muscular Dystrophy
- Organ transplant other than kidney or cornea
- Organic Brain Syndrome
- Paralysis
- Parkinson’s disease
- Scleroderma
- Schizophrenia or other forms of psychosis
- Systemic Lupus
- Transient Ischemic Attached (TIA) within 2 years or more than one TIA
Your height and weight can also become a significant factor in getting approved for coverage. Each insurance carrier may have different qualifications regarding which ratios they will consider. While smoking won’t result in a decline in coverage, certain usage could lower your health rating.
Getting Approved for Coverage
When you work with an experienced LTC specialist, you gain a better chance of getting approved for coverage with the right carrier. If you’re wondering if you could be eligible for LTCI, request a quote and connect with an LTC Consumer LTC specialist today to find the right fit for you.
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