This blog post is designed to provide general information on the subjects covered. It is not, however, intended to provide specific estate planning, insurance, tax or legal advice. Please note that LTC Consumer and its representatives do not give financial planning, tax or legal advice. You are encouraged to consult with your tax advisor or attorney concerning your own situation.

Do You Qualify for Long Term Care Insurance?

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Long Term Care Insurance (LTCI) underwriting differs from most other insurances you buy. Auto and Homeowners insurance rarely ask personal questions about your health while Life insurance gets more personal with physicals and urine, blood, and saliva tests.

Many people think since they passed Life insurance underwriting they’ll qualify for Long Term Care Insurance. Unfortunately, that’s not always the case. With Life insurance, insurance carriers are underwriting for your mortality. With Long Term Care insurance, they underwrite for your morbidity.

What’s the Difference? Mortality vs. Morbidity

Mortality refers to the state of being alive or mortal and the rate of death in a population. Morbidity is the unhealthy state of an individual and the presence of disease.

LTCI underwriters review your medical records and conduct phone and/or in-person interviews looking to rule out unhealthy individuals with the presence of disease. Unhealthy individuals will not be extended coverage because it puts the insurer at higher risk for claims sooner than expected, with some claims lasting longer than expected.

Pre-Underwriting Health Questionnaire

When you work with an LTC Specialist, they can identify if you have health issues that may result in an automatic decline of coverage. The Specialist will ask you a few questions about your current health and history to rule out any red flags that would be immediately caught and declined by an underwriter.

LTC Specialists are also familiar with different carrier underwriting standards. They may help you get coverage with a carrier who is more lenient in one health issue versus another.

We recommend being honest and open about your health as you begin the LTCI application process. What you don’t share will show up later in medical records or interviews and may lead to an automatic decline in coverage.

Common Reasons for Automatic LTCI Declines

Curious if you qualify for LTCI? Review these top reasons for automatic declines.

  • Need help with any of the six activities of daily living (eating, bathing, dressing, transferring to a bed or chair, toileting, and continence)
  • Use a walker, wheelchair, cane, or motorized scooter
  • On kidney dialysis, oxygen, nebulizer, or ventilator
  • In physical therapy
  • Use of narcotic pain medications
  • Receiving disability benefits

Common Diagnoses Resulting in a Decline

If you are currently experiencing or have been diagnosed with one of these conditions in your health history, you will likely be declined LTCI coverage.

  • AIDS/HIV+
  • Alzheimer’s
  • ALS or Lou Gehrig’s disease
  • Cancers of bone, brain, esophagus, liver, pancreas, or stomach
  • Cirrhosis of the liver
  • Congested heart failure
  • Cystic Fibrosis
  • Dementia
  • Chronic kidney disease
  • Metastatic cancer
  • Multiple Sclerosis
  • Muscular Dystrophy
  • Organ transplant (except kidney or cornea)
  • Paralysis
  • Parkinson’s disease
  • Scleroderma
  • Schizophrenia
  • Transient Ischemic Attack (TIA) within two years, or more than one TIA

At LTC Consumer, we help individuals find out if they qualify for Long Term Care insurance and help clients through the approval process. Get in touch with an LTC Specialist today to see if you may be eligible for coverage.

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