What disqualifies you from long-term care insurance coverage?

Many seniors find that long-term care insurance is an important component of their financial planning. This type of insurance helps cover the cost of extended care services, such as nursing homes, assisted living, and in-home care, which can be prohibitively expensive — and may not be covered by Medicare or even Medicare supplemental insurance. 

And, given that long-term care can come with an average cost of thousands of dollars per month (or more), it can make a lot of sense for seniors to purchase this type of coverage. But while it can be a smart way to ensure you're covered for these types of expenses, not everyone will be eligible for long-term care insurance. Insurers assess various factors to determine an applicant's eligibility and the policy price — and some factors can even disqualify you from obtaining long-term care insurance.

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What disqualifies you from long-term care insurance coverage?

While the requirements vary from one long-term care insurance provider to the next, there are a few factors that could disqualify you from coverage, including:

Your age

One of the primary factors that insurers consider when evaluating applicants for long-term care insurance is age. Generally, the younger you are when you apply for coverage, the more likely you are to qualify. 

Insurance companies are hesitant to provide coverage to individuals who are already in need of long-term care or are likely to need it soon. While there is no specific age at which you become ineligible, getting coverage becomes more challenging as you get older, and premiums tend to increase significantly. 

That's part of why it's important to apply for long-term care coverage as early as possible. It will help keep the costs of your premiums down and potentially keep you from being denied coverage altogether.

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Pre-existing health conditions

Your current health status plays a crucial role in determining your eligibility, and long-term care insurance companies typically conduct a thorough medical underwriting process to assess your health. 

If you have significant pre-existing health conditions, such as Alzheimer's disease, Parkinson's disease or severe heart disease, you may be disqualified from obtaining coverage. Even if you are approved, your premiums may be substantially higher if you have pre-existing conditions.

Recent health events

Recent health events can also impact your eligibility for long-term care insurance. If you have experienced a significant health event, such as a stroke or cancer diagnosis, within a certain timeframe before applying for coverage, insurers may either disqualify you or impose waiting periods before providing coverage. The length of these waiting periods varies between insurance companies.

Cognitive impairments

Cognitive impairments, such as dementia or Alzheimer's disease, can disqualify you from long-term care insurance. These conditions are considered high-risk factors for insurers, as they often require extensive and long-term care. Applicants with cognitive impairments may be denied coverage, or their premiums may be exorbitant.

Functional limitations

Insurance companies may assess your ability to perform daily activities independently, known as activities of daily living (ADLs). If you have limitations in ADLs when applying, such as bathing, dressing, eating, transferring and continence, you may be deemed ineligible for long-term care insurance. The severity and duration of these limitations can impact the insurer's decision.

Terminal illness

When applying for coverage, individuals with terminal illnesses, such as advanced-stage cancer, may not qualify for long-term care insurance. Since these individuals may require extensive medical care and have a limited life expectancy, insurance companies may not be willing to provide coverage for long-term care services.

The bottom line

Long-term care insurance can provide valuable financial protection in case you need extended care services in the future. However, several factors can disqualify you from obtaining coverage, including age, pre-existing health conditions, recent health events, cognitive impairments, functional limitations and terminal illnesses. It's essential to carefully evaluate your eligibility and consider your options when planning for long-term care needs. If you are disqualified from traditional long-term care insurance, you may find it helpful to explore alternatives, such as Medicaid or self-funding, to ensure you have a plan in place for your long-term care needs.