How to get long-term care insurance with pre-existing conditions

Aging Americans face hefty healthcare costs. In fact, the typical nursing room costs seniors $104,000 annually — and that's for a shared room. Even in-home services can come with huge price tags, ranging from $5,720 to $6,292 per month, according to data from Genworth.

Long-term care insurance policies can be a solution for covering these costs. The key is getting a policy before your health turns south, as this can make it difficult to qualify or make your premiums significantly more expensive.

"Long-term care insurance policies require medical underwriting, where insurance companies evaluate your health history and current medical condition," says Susana Zinn, an independent life insurance agent in Miami Beach, Fla. "Pre-existing conditions will surely affect eligibility for coverage."

Still, it's not impossible. Are you considering getting long-term care insurance coverage but already have a pre-existing condition or two? Here's what experts say to do. 

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How to get long-term care insurance with pre-existing conditions

If you want to purchase a long-term care insurance policy with pre-existing conditions, it may help to do the following:

Understand what would qualify as a pre-existing condition

The first step is to understand what medical conditions might — and might not — impact your long-term care insurance options. 

"High blood pressure — controlled — is probably not a big deal for any type of long-term care policy," says Mike Raines, owner of Raines Insurance Group. "But a history of cancer, dementia, or diabetes can be difficult to get approved for with traditional long-term care policies."

According to Mark Baron, owner of Baron Long-term Care Planning, taking anti-anxiety or cholesterol medications is likely fine, too. You should also consider how your conditions combine together, Baron says. 

"Long-term care insurance is available to those with many pre-existing conditions, but it depends on what the condition is," Baron says. "Some conditions that would normally be insurable may not be when combined with another insurable condition. These are called comorbid conditions."

This might include having diabetes and heart disease simultaneously or having a history of COVID-19 and some sort of respiratory condition. 

"Then there are some issues that are an outright decline by all companies," Baron says. "If someone has been diagnosed with Multiple Sclerosis, Alzheimer's, dementia, Parkinson's, AIDS, and several other medical issues, they can't buy long-term care insurance."

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Compare insurers

Insurers vary on what they consider pre-existing conditions — and how they treat them — so if you have any sort of pre-existing issue, you'll want to shop around before deciding who to apply with.

"Different insurers have varying underwriting criteria," Zinn says. "Look for insurers who specialize in high-risk applicants or have more lenient policies on pre-existing conditions." 

According to Baron, insurers also have different approaches to long-term care insurance pricing when it comes to pre-existing conditions. While some price-based on your health and the conditions and medications you have, others use a pass-fail system, with a single price for all those who "pass." These approaches can result in two very different premiums, depending on your conditions. 

For this reason, you may want to use an independent insurance agent when shopping around for your policy. 

"An experienced broker can guide you to insurers more likely to accept applicants with pre-existing conditions and help navigate the underwriting process," Zinn says.

Look to your employer

In addition to comparing long-term care insurance companies and talking to an independent agent, you should also work with your employer's human resources department if you're still working. 

"Some employers or organizations offer group long-term care insurance," Zinn says. "These may have less stringent underwriting or guaranteed acceptance." 

Guaranteed acceptance policies don't require medical underwriting or any exams. Even applicants with pre-existing conditions are approved automatically.

If you are approved

If you are approved for a long-term care insurance policy, set your expectations. For one, you might get a higher premium than you'd like. 

"It's likely that premiums will be higher for those with pre-existing conditions," Zinn says. "The additional risk associated with these conditions leads insurers to increase premiums to cover potential future claims."

You also might face waiting periods for coverage of certain conditions or treatments. These typically last anywhere from six months to two years, depending on this issue. 

The bottom line

If you want an affordable long-term care insurance policy, the best option is to apply early — at a young age and before you start having health issues. And if you're worried you won't qualify or get a premium you can afford, explore other options. Many life insurance policies offer long-term care benefits these days, and there are also annuities you can use in a similar fashion. 

These can be easier to qualify for than long-term care policies and are often more affordable. "If the client dies healthy, there will also be a death benefit lump-sum of money that is income-tax-free for the beneficiaries," Zinn says.