How to Qualify for Long Term Care Insurance

Qualify for Long Term Care Coverage

Long term care insurance (LTCI) is underwritten by insurance companies, and premiums are based on your age and health history.

If you wait to apply, the cost for coverage rises each year. Once you’re insured, your premiums are locked in at the age you buy and do not increase each year simply because you age.

Equally important is the health screening process to be approved. Certain medical conditions may make you ineligible for coverage, so it’s important to apply for insurance before an unforeseen injury or illness makes you uninsurable.

Keep reading to learn how to qualify for long term care insurance and other factors that go in to the process of obtaining coverage.

Health Screening and Underwriting

When applying for coverage, many insurance carriers require a telephone health interview and will request to review your official medical records. Depending on your age and health issues, a face-to-face assessment in your home may be required too.

The underwriting process typically takes from 4 – 6 weeks depending on how quickly your medical records are received and reviewed.

It is important to know what your doctors may have written in your medical records. Just as you can check your credit score, you have the right to check your medical records too.

You can get a copy of your medical records from the Medical Information Bureau (MIB) and request access to your prescription drugs records (another point carriers will reference during underwriting) from your state Prescription Drug Monitoring Program.

Qualify for Important LTC Coverage

Cognitive impairment such as dementia and Alzheimer’s are a few of the main reasons people purchase LTCI, so insurers pay close attention to these medical diagnoses. If an applicant has any indication of cognitive impairment in their medical records, carriers will use standardized tests during the phone or face-to-face interview. The tests are the Minnesota Cognitive Acuity Screen (MCAS) and the Enhanced Mental Skills Test (EMST).

The MCAS test contains a variety of exercises including delayed word recall, naming and number sequences, and comprehension questions. The EMST tests applicants on word driven recall exercises.

Helpful Hint: To speed up the application/underwriting process, call your doctors to let them know you applied for long term care insurance and provide the name of the insurance carrier. Ask them to respond to medical record requests promptly to avoid delay.

Common Conditions & Reasons for Insurance Ineligibility

Top Reasons for Decline:

  • Needing assistance with bathing, eating, dressing, transferring to a bed or chair, toileting, or continence
  • Receiving home care, adult day 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
Physical Therapy
Currently in physical therapy? That is one of the top reasons of being declined long term care insurance.

Common Diagnoses Declined:

  • Alzheimer’s
  • Amputation due to disease
  • Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease)
  • Cancer of bone, brain, esophagus, liver, pancreas , stomach
  • Cirrhosis of the liver
  • Congestive Heart Failure (CHF)
  • Cystic Fibrosis
  • Dementia
  • Frequent/Persistent forgetfulness or memory loss
  • Huntington’s Chorea
  • Chronic Kidney Disease
  • Metastatic Cancer (spread from original site)
  • Multiple Sclerosis
  • 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 Attack (TIA) within 2 years or more an one TIA
Doctor Examining Male Patient With Knee Pain

Tobacco Use

The following information shows how some of the top LTC insurance carriers rate occasional tobacco use.

Company 1 – Nicotine

  • Within 2 years and no medical problems = Preferred
  • Within 2 years with chronic upper respiratory infections = Rated or decline
  • Within 2 years with diabetes, heart or lung disease = Decline

Company 2 – Tobacco Use

  • Within 2 years = Standard health rating
  • Within 1 year in combination with co-morbid condition = Class 1 health rating or decline
  • Celebratory cigar up to 1 per month = Standard health rating – may qualify for a Preferred health rating if all requirements listed under the Preferred Rate Criteria are met.
  • CBC abnormal with polycythemia or hypoxia = Decline

Company 3– Tobacco Use

  • No tobacco/nicotine use within the past 24 months, including occasional cigar or pipe use, and tobacco chewing = Preferred health rating
  • Tobacco use in combination with Angina, Asthma or COPD = Decline

Health Ratings

The majority of people who apply for long term care insurance receive a Standard health rating. If you are given a clean bill of health, you may qualify to receive the best possible rates, which are sometimes referred to as preferred health rates, although the name may vary by carrier.

The insurance carrier will determine your health rating during underwriting and the rates that are offered to you are priced accordingly. Substandard or higher risk rate classes are available with some carriers based on the diagnosis or treatment of conditions. You may be issued a policy, but the premiums are much higher.

Professional Long Term Care Planning

Insurance carriers have different underwriting standards. So, it’s best to work with a professional who knows where and how to find the carrier that offers the best chances of getting you covered. A long term care insurance specialist will shop the marketplace on your behalf to save you valuable time and money.

Don’t delay. Take advantage of your good health today. Request a quote.

If you'd like to learn at your own pace without speaking to anyone, click the button below and provide your email address.  We will send you a pre-recorded educational webinar with a great overview of what Long Term Care Insurance is, what is covered and some generic cost estimates.

Recommended Reading

View the average cost of long term care in your state.

Learn the meaning of the most commonly used LTC terms.

Find answers to popular questions in LTC.