Long-term care insurance disqualifications hit hard and fast. Age limits typically max out between 80 and 85—game over for most seniors. Pre-existing conditions like Alzheimer’s, Parkinson’s, severe heart disease, or advanced diabetes trigger automatic denials. Need help with two or more daily activities? Rejected. Failed a cognitive test? Rejected. Using a walker or wheelchair? Probably rejected. Recent hospitalizations, strokes, substance abuse history, or mental health issues all wave red flags at underwriters. The fine print reveals why so many applications end in disappointment.
Design Highlights
- Age exceeding 80-85 years old typically disqualifies applicants, with most insurers refusing coverage by age 85.
- Pre-existing conditions like Alzheimer’s, Parkinson’s, ALS, severe heart disease, or advanced diabetes result in automatic denial.
- Cognitive impairments including dementia, failed mental status exams, or requiring supervision for safety disqualify applicants.
- Needing assistance with two or more daily living activities or using mobility aids leads to rejection.
- Recent hospitalizations, strokes, major surgeries, substance abuse history, or serious mental illness increase disqualification risk.
While most people worry about whether they can afford long-term care insurance, plenty discover they can’t even qualify for it in the first place. Age alone can shut the door. Most insurers draw the line somewhere between 80 and 85 years old. By 85, nearly everyone faces disqualification. And even if someone applies earlier, premiums skyrocket with age—rates can jump 79% from 55 to 65. Getting older costs more, assuming insurers will even take the application.
Age doesn’t just make long-term care insurance expensive—for many, it makes getting approved impossible before they even see the premium.
Pre-existing medical conditions present another brick wall. Alzheimer’s, Parkinson’s, ALS, advanced cancer—these conditions trigger automatic denials. Severe heart disease, congestive heart failure, cardiomyopathy. The list goes on. Chronic illnesses like lupus, cystic fibrosis, and advanced diabetes also make applicants uninsurable. Kidney failure, spinal cord injury, cerebral palsy. Insurers comb through medical records hunting for anything suggesting someone will need care soon. Because that’s the kiss of death for approval.
Cognitive impairments are deal-breakers. Dementia and Alzheimer’s top the list. Failed cognitive tests like the Mini Mental Status Exam result in immediate rejection. Memory loss affecting orientation to time or place? Disqualified. Can’t manage medications independently? Disqualified. Need supervision for safety? Also disqualified. Mental decline signals imminent need for long-term care, and insurers aren’t interested in that gamble.
Functional limitations also destroy eligibility. Needing help with two or more activities of daily living means denial. Using mobility aids—wheelchairs, walkers, even canes—typically disqualifies applicants. Already living in a nursing facility? Forget it. Requiring oxygen therapy, dialysis, or a hospital bed? Grounds for rejection. The inability to perform basic self-care tasks makes someone uninsurable. Insurance companies want to avoid covering individuals who will immediately need services like in-home aides or assisted living.
Terminal illnesses automatically trigger rejection. Metastatic cancer, end-stage organ failure—these conditions indicate imminent need for care. Insurers evaluate remaining life expectancy against financial risk. Any condition with a prognosis under two years is typically excluded. These policies are designed for long-term care, not end-of-life care.
Recent health events complicate matters too. Recent hospitalizations, major surgeries, strokes, heart attacks, neurological events—all high-risk factors. Rehabilitation stays flag applicants as risky. Insurers may require waiting periods before reapplying after health setbacks. COVID-19 infections can significantly impact eligibility, particularly for older applicants.
Substance abuse history frequently leads to denial. Serious mental illnesses like schizophrenia or severe depression may result in rejection. Hospitalization for mental health issues increases risk. Use of antipsychotic medications can disqualify applicants. Insurers view substance abuse and severe mental illness as red flags indicating future care needs. Specific policy exclusions vary by insurer and can eliminate coverage for certain conditions or care settings that applicants assume are included.
Frequently Asked Questions
Can I Reapply for Long-Term Care Insurance After Being Denied?
Yes, reapplication is possible and often happens immediately. Most applicants try again the following month since benefits calculate monthly anyway.
Here’s the deal: improved health changes everything. Recovery from recent issues, stabilized medications, or corrected medical records can flip a denial to approval.
Different insurance companies use different underwriting standards, so getting rejected by one doesn’t mean all will say no. Some folks explore hybrid policies combining long-term care with life insurance instead.
Does My Family Medical History Affect My Insurance Eligibility?
Family medical history matters, but it’s not the deal-breaker most people think.
Insurers care way more about current health status than what happened to grandma.
That said, a family loaded with Alzheimer’s or dementia cases? Yeah, that raises red flags.
Underwriters get nervous about hereditary cognitive decline because those claims get expensive, fast.
It might bump up premiums or trigger extra scrutiny, but rarely causes outright denial unless paired with existing symptoms or conditions.
Are There Alternative Coverage Options if I’m Disqualified?
Yes, several alternatives exist. Medicaid covers long-term care for those meeting income and asset limits—no medical underwriting required.
Medicare handles skilled nursing for up to 100 days post-hospitalization. Some Medicare Advantage plans throw in extra long-term care perks.
There’s also Medigap for coverage gaps. Veterans can tap into VA benefits.
Life insurance policies with long-term care riders work too. Hybrid products combining life insurance and long-term care exist.
Options vary by state and individual circumstances.
How Long Does the Underwriting Process Typically Take?
The underwriting process typically drags on for 5-8 weeks, averaging around 35 days.
Younger applicants aged 30-50 get the express lane—sometimes decisions land within 1-20 business days.
But here’s the kicker: older folks face longer waits. Medical records requests eat up about 21 days alone, and that’s assuming doctors actually respond promptly. Spoiler alert—they often don’t.
Once all requirements are in, expect a decision within 5 business days.
Will My Prescription Medications Be Reviewed During the Application?
Yes, prescription medications get reviewed during the application process. Insurers dig into everything—dosage, what conditions the meds treat, how many pills someone’s popping daily.
They’re looking for red flags like drugs for cognitive decline, Parkinson’s, or complex polypharmacy situations. The whole medication profile gets cross-checked against medical records.
It’s not just prescriptions either; they want to know about over-the-counter stuff, supplements, herbs—the works. Pharmacists or qualified reviewers typically handle this part of underwriting.
