What Disqualifies You From Long-Term Care Insurance?

Shawn Plummer

CEO, The Annuity Expert

This guide aims to shed light on what disqualifies you from long-term care insurance to help you navigate the path to securing your future health needs. Long-term care insurance is a crucial part of this equation – a safety net designed to support you when you need it most. But what if certain factors disqualify you from this essential safeguard? Read on to find out what disqualifies from long-term care insurance.

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What Disqualifies You From Long-Term Care Insurance?

Your health status significantly determines your eligibility for long-term care insurance, even if you have Medicare coverage. Insurance companies evaluate applicants’ health history and current conditions to assess risk. Conditions such as Alzheimer’s disease, certain types of cancer, or chronic illnesses like Multiple Sclerosis could disqualify an applicant in the long-term care insurance eligibility assessment, regardless of their Medicare enrollment.

Example: If a 65-year-old applicant has recently been diagnosed with Alzheimer’s, the insurance company would likely deem them too high-risk for long-term care coverage.

What Disqualifies You From Long-Term Care Insurance

The Importance of Age and Timing

Another crucial factor that insurance providers look at is age. If you apply when you’re older or already needing long-term care, you might face rejection. The best strategy is to apply while you’re still relatively young and healthy, as the chances of disqualification increase with age.

Example: A healthy 55-year-old applicant is more likely to be accepted for long-term care insurance than an equally healthy 75-year-old.

Financial Barriers

Financial considerations also come into play when applying for long-term care insurance. Providers assess your income and assets to ensure you can afford the premiums. You may be disqualified if your income or limited assets are low.

Example: An applicant with a limited income may struggle to afford the regular premiums and might be considered unsuitable for long-term care insurance.

Disqualifying Conditions For Long-Term Care Insurance

Lifestyle and Personal Habits

Some lifestyle factors can also impact your qualification for long-term care insurance. Risky behaviors, such as smoking or excessive alcohol consumption, can lead to disqualification. Similarly, high-risk occupations or hobbies could also be a factor.

Example: A 45-year-old heavy smoker with a high-risk occupation such as firefighting could be considered too risky to insure.

Past Claims and Insurance History

Your insurance history, including past claims and previous coverage, may also impact your eligibility. If you have a history of frequent claims or have had insurance coverage denied or canceled, it could work against you.

Example: An applicant with previous long-term care insurance coverage canceled due to non-payment of premiums may face disqualification.

What Disqualifies You From Long-Term Insurance

Alternatives To Long-Term Care Insurance

Annuities, particularly those with long-term care riders, offer a viable alternative to traditional long-term care insurance. They provide flexibility, allowing funds to be used for other purposes if long-term care is not needed. Unlike long-term care insurance, many annuities guarantee benefits to your beneficiaries if unused for care, making them more advantageous for those with better health. Furthermore, qualifying for an annuity is often less stringent health-wise. However, it’s crucial to consider your financial situation, health status, and retirement planning strategy before choosing between the two.

Next Steps

Remember, the goal of getting long-term care insurance with pre-existing conditions is to ensure you can manage the cost while meeting the insurer’s risk criteria. Being aware of these disqualifying factors and planning accordingly is your first step towards securing the long-term care you may need in the future. We hope this guide has empowered you with the knowledge to take that step confidently and wisely because your health and peace of mind are worth it.

What Disqualifies You From Ltci

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Frequently Asked Questions

Why would long-term care insurance be denied?

Insufficient evidence or documentation is a frequent cause for the denial of long-term care insurance claims. Insurance companies require complete records and documentation to assess the eligibility of claims. Inadequate or deficient records will lead to claim denials.

What five factors should you consider when buying long-term care insurance?

Can you please tell me your current age, the time you won’t receive benefit payments, the waiting period before benefits start, the amount of daily benefit, and whether you want inflation protection?

What triggers a long-term care claim?

Long-term care insurance benefits are typically triggered by two events: experiencing severe cognitive impairment or inability to perform two daily activities, such as dressing or feeding oneself.

Shawn Plummer

CEO, The Annuity Expert

I’m a licensed financial professional focusing on annuities and insurance for more than a decade. My former role was training financial advisors, including for a Fortune Global 500 insurance company. I’ve been featured in Time Magazine, Yahoo! Finance, MSN, SmartAsset, Entrepreneur, Bloomberg, The Simple Dollar, U.S. News and World Report, and Women’s Health Magazine.

The Annuity Expert is an online insurance agency servicing consumers across the United States. My goal is to help you take the guesswork out of retirement planning or find the best insurance coverage at the cheapest rates for you. 

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