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Your Health Will Determine Ability to Obtain Long-Term Care Insurance

Your ability to obtain a Long-Term Care Insurance policy requires medical underwriting in order to determine if your health fits their guidelines. The idea is to get your application approved. Your health can … and does change at a moment’s notice. You must health qualify in order to obtain a Long-Term Care Insurance Policy. Every company has different guidelines and those guidelines can vary on certain health issues dramatically. One thing is for certain, if you need care now you will not be eligible to get a policy.

You may have heard the phrase “your fragile 50’s”. Once you hit 50, you quickly realize that the changes to your body and mind aren't coming — they're here. This is a normal part of aging that many people would rather not think about. As you age, your odds of developing aches, pains, and most diseases steadily rise. Some of these issues may impact your ability to qualify for long-term care insurance. Other issues are just a preview of what will happen in the next 15 – 20 – 25 years down the road. These issues start increasing as you get in your 60’s. This is one of many reasons why most people who get Long-Term Care Insurance do so before they retire.

Women in their 50’s, whose bodies are now transitioning through menopause, start to see and feel physical changes and health issues emerging.

Issues men and women start to face as they get in their 50’s and their impact on underwriting

Hypertension & Coronary Artery Disease

High blood pressure and early heart issues include elevated cholesterol. Insurance companies want good control for hypertension. Guidelines are getting more conservative for doctors and this may lead to insurance companies wanting even better control. Remember, if you take blood pressure medication, which successfully controls your blood pressure, you still have hypertension. Without medication your blood pressure will go back up. Over time you may find that your medication is no longer working as well. You may be placed on a second medication or your doctor will change the dosage. Recent changes to your medication may require wait periods.

If you have had heart surgery, or even a heart attack, you may still qualify for Long-Term Care Insurance. You must have had a full recovery and a wait period which can vary from company to company. Generally, a pending surgery will make you uninsurable until a successful completion of the procedure.

Obesity

Yes, many people do add weight as they age. weight as we age. Most of us are not at our college weight. Maintaining a good weight is harder as we age. While men gain weight due to lifestyle changes and slowing of their metabolism, women have an even bigger problem as menopause-related hormone and metabolism changes make major weight gain an issue for them.

Luckily, Long-Term Care Insurance companies have fairly wide height/weight guidelines. In order to get the lowest premium with what they call “preferred” rates you shouldn’t be “too short” for your weight. This is a nice way to say that if you weigh too much it can cost you or even make you uninsurable.

For example, a 6-foot-tall person wanting preferred rate could weigh as much as 214lbs to 250lbs depending on company. If that 6-foot person is over 300lbs most companies would not consider at all.

Osteoarthritis

Yes, you have more aches and pains. The most common form of arthritis, osteoarthritis, refers to the breakdown of the cartilage in your joints. The Arthritis Foundation says women are more likely than men to develop osteoarthritis, especially after age 50. This disease tends to show up in your knees and hips, according to statistics from the Centers for Disease Control and Prevention.

If you require prescription pain medication for your arthritis discomfort, then it could impact insurability depending on the type of medication you require.

Gout

Usually starting in your big toe, Gout is characterized by throbbing pain and swelling. It comes from a buildup of uric acid—usually due to poor kidney function. Research, published in the Journal of Clinical Rheumatology, concludes gout is most likely to strike around your 50th birthday, especially if you're putting on weight.

If your gout is being treated, it usually will not be an underwriting issue.

Gum Disease

Your risk for gum issues doubles when you hit 50. Moderate to severe periodontal disease symptoms include bad breath that won't go away, tender or bleeding gums, and painful chewing. You could lose your teeth, but perhaps an even bigger concern is untreated gum issues will increase your risk for heart disease, arthritis, and other more serious health problems.

Go to the dentist. As far as the impact on Long-Term Care Insurance underwriting unless, you have more serious health issues, the impact will be more on your friends (because of teeth appearance, bad breath, etc.)

Ovarian Cancer/Prostate Cancer

While this form of cancer can strike at any age, Ovarian Cancer is most likely to show up during your 50s and 60s. Bloating, pelvic pain, and the sudden need to pee are all warning signs. Also, women who started menstruating before age 12 or experienced menopause after age 50 are at greater risk, according to resources from Johns Hopkins Medicine. Ovarian cancer will impact underwriting depending on the stage of your cancer and when you successfully completed treatment.

Prostate cancer is the most common cancer among men (after skin cancer), but it can often be treated successfully. About 1 man in 7 will be diagnosed with prostate cancer during his lifetime. While Prostate Cancer develops mainly in older men (about 6 cases in 10 are diagnosed in men aged 65 or older), many men see rising PSA levels or get a diagnosis in their 50’s. It is rare to occur before age 40. Prostate-specific antigen, or PSA, is tested as part of your normal check-ups. A high PSA level or current cancer will impact underwriting. Wait periods will be required following treatment.

Early-Onset Alzheimer's

Most people think about Alzheimer’s or dementia as being an old person’s disease. One of the major reasons people get Long-Term Care Insurance is because of the ever-increasing amount of people who suffer from memory issues. This requires supervision and care which is not paid for by health insurance or Medicare. However, some people suffer from early onset memory problems. Early symptoms might not even be noticed by your family. Most insurance companies will complete a memory test for applicants for Long-Term Care Insurance over age 60 or, if you have a family history of memory loss.

The Mayo Clinic says 5% of people first experience symptoms in their 50s and early 60s. If you have already been diagnosed with any type of memory problem you are uninsurable, period. If you have a family history, it won’t impact your insurability, however most companies will not only order word recall testing, but will not give you preferred rates.

If you have family history, you should obtain Long-Term Care Insurance in your 40’s or early 50’s to be safe.

Underwriting and the Process

No matter what your age every insurance company will complete full underwriting for your Long-Term Care Insurance application. Premiums are based on your age and health history in addition to the amount of benefit you apply for.

Age is the first consideration and your premium is based on that age and is intended to remain level. If you wait to apply, the cost for coverage rises each year you wait. Once you’re insured, your premiums are locked in at the age you buy and do not increase each year simply because you age. This doesn’t mean they can never go up – read more here: Policy Rate Increases.

Waiting also has an impact on your health status at that time. Certain health conditions may make you ineligible for coverage, or could place you in a “rated category”, which means your premium would be higher than normal. This is the reason why you should apply for Long-Term Care Insurance before an accident, injury, or illness makes you uninsurable or more difficult to insure.

How To Qualify For Long-Term Care Insurance and Underwriting Factors

Underwriting

The health screening process starts even before you meet with Matt McCann or make an application. Before you make an appointment (complete this form to get free quotes and review options - https://mccannltc.net/quote), an assistant will ask you several quick health questions. This would include your current medications, height and weight, tobacco use, and surgery history.

Matt will collect more detailed health history, including your family history, when you meet with him. Matt helps people nationwide using his unique process in which you speak with him on the phone while viewing his computer screen on your computer. He works with all the major companies in Long-Term Care and each company has different underwriting standards and premium rates. It is very important that you are fully honest with Matt as he is working on your behalf to find appropriate coverage that you could qualify for at the lowest premium.

If you decide to apply, the process takes about six weeks. It starts with an application. Matt will help you complete, usually electronically. This includes a HIPAA release for medical records, Medical Information Bureau Report, and Rx history. You do not pay anything.

You will receive a package from Matt’s office, which includes product brochures and other related material. It will also will include a paper copy of the medical release. While many doctors and facilities will accept an electronic signature, some don’t. Matt’s office is proactive to make it go much faster.

When applying for coverage, most insurance companies will require a telephone health interview. You should treat the interview seriously and focus on the questions being asked. Only answer the questions that are asked by the nurse. Do not joke about health issues or memory problems. They will take your comments seriously. Depending on your age and health issues, a face-to-face assessment in your home may be required too.

A nurse will review your health history and lifestyle. You may be asked to complete a word recall or other memory testing. The insurance companies use standardized tests during the phone or face-to-face interview. The tests are the Minnesota Cognitive Acuity Screen (MCAS) and the Enhanced Mental Skills Test (EMST).

The MCAS test contains a variety of exercises including delayed word recall, naming and number sequences, and comprehension questions. The EMST tests applicants on word driven recall exercises.

Blood or urine will not be asked for. This information is obtained from your medical records. If you have not been to a doctor in a very long time, you might be asked to get blood work from a doctor.

Depending on how quickly your medical records are received and reviewed will determine how long this process lasts. Some doctor’s offices are slow at responding. Matt McCann’s office will attempt to intervene on your behalf if necessary. On occasion, you may have to call the office and ask them to process the request. Your doctor’s office is compensated for the records, but keep in mind, your records are your records. You have the legal right to have records forwarded for any reason, so your doctor must honor your request.

In the event the insurance company declines your application you will be notified in detail by mail. If the information is correct, Matt McCann will seek another option from another company. However, on occasion you may disagree with the information in your medical records. Sometimes the information is incorrect or incomplete. A letter from your doctor may be requested to address an issue. An appeal would be made of the decision. With updated information, an underwriter may overturn their decision.

Hint: To speed up the process, many people call their doctor’s office to let them know they applied for Long-Term Care Insurance and ask them to respond to medical record requests quickly to avoid delays.

Common Conditions and Reasons For Disqualification

Matt will not allow you to apply if you have any of the following issues. If you did apply your application would immediately be rejected:

  • If you now require assistance with bathing, eating, dressing, transferring to a bed or chair, toileting, or continence
  • If you are now receiving care in your home, adult day care, assisted living facility or nursing home, or memory care unit
  • If you use of a walker, wheelchair, quad cane, motorized scooter, nebulizer, ventilator, hospital bed, oxygen, or kidney dialysis
  • If you currently use a number of medications including narcotic pain medications
  • If you are currently receiving physical therapy
  • If you are on social security disability

These are some common reasons you will not be allowed to apply for reason for immediate decline:

  • AIDS/HIV+
  • Alzheimer’s
  • Amputation due to disease
  • Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease)
  • Current cancer
  • Cirrhosis of the liver
  • Congestive Heart Failure (CHF)
  • Cystic Fibrosis
  • Dementia
  • Frequent/Persistent forgetfulness or memory loss
  • Huntington’s Chorea
  • Chronic Kidney Disease
  • History of Metastatic Cancer (spread from original site)
  • Multiple Sclerosis
  • Muscular Dystrophy
  • Most Organ Transplants
  • Organic Brain Syndrome
  • Paralysis
  • Parkinson’s Disease
  • Scleroderma
  • Schizophrenia or other forms of Psychosis
  • Systemic Lupus
  • Stoke with residues or multiple strokes or TIA’s
Underwriting Class

Most insurance companies have two or more underwriting classes based on your health, height/weight, your lab work at the doctor, tobacco use, and other criteria. The underwriter’s job is to approve at the best rate possible. While most people get the standard rating, people do get preferred rates. If you are under 60, you have a much better chance of getting approved preferred (which is the best rate class with the lowest premium). Often Matt McCann will quote the standard rate but you may get approved at the preferred rate. Usually people are very happy if the premium comes back lower than expected!

Delivery of Your Policy

Matt’s office keeps you updated during the underwriting process. Once a decision is made by the insurance company you will be notified. If approved, your policy will be mailed to you and a time will be set for Matt to review your coverage with you in detail.

You will then be required to sign enclosed delivery receipts and return any premium which is due. Always write the check payable to the insurance company. Mail the receipts and check promptly as a time limit exists.

If you’ve elected to pay by monthly electronic draft from your account, no check will be required. Most people pay annually as it is the least costly method, however some people select monthly bank draft for convenience. You can change your method in the future.

If you or a spouse/partner gets declined this is what will happen:

  • Review the reasons for decline and start appeal process.
    • Discover if errors in medical records exist and obtain correct information.
    • Notes in records sometimes get misinterpreted and a doctor’s letter will be requested.
  • Generally, if decline information is correct, an alternative solution will be found, if possible and the application process would be started.
    • If one spouse/partner gets declined, the approved spouse will have their policy as we find appropriate coverage for the other. It becomes very important that at least one spouse has a policy in place even if coverage can’t be obtained for the other.

Never hesitate to contact Matt or his office if you or a family member have questions about your coverage in the future. Matt has helped people since 1998, and is dedicated to help you and your family down the road.

Using an Experienced Long-Term Care Specialist

Most insurance agents and financial planners don’t understand underwriting. As you will notice, Matt McCann and his staff will make every effort to match you with the best coverage at the best value based on your age and health. Insurance companies have different underwriting rules, so deciding on which insurance company requires knowing as much about you and your health history, as well as family history, in order to make the best recommendation.

Insurance rates are regulated so one insurance agent can’t promise you that they can get you “a deal”. The approved published rates and underwriting standards are filed at the state’s department of insurance.

The difference is the knowledge of underwriting, the knowledge of how policies work at the time of claim, and an understanding of what your goals and concerns happen to be. Over insurance only benefits the insurance company and the insurance agent. Matt McCann’s general philosophy is to provide you with the most affordable coverage. You have the choice of quality care in the setting you desire while protecting the lifestyle of a spouse/partner and family without draining assets. There are very few agents in the country that have the experience and knowledge that Matt has. Matt and his team will make every effort to find you the best coverage, if appropriate for you, at the best value matching your age, health and finances.

If you live in a Long-Term Care Partnership State a partnership plan might be your best option. These plans require by law certain benefits like inflation benefits. The partnership policy provides dollar-for-dollar asset protection. Learn more about partnership here:

State Partnership Policy Information

Find the availability of partnership plans and available tax incentives here: Find Your State

Final Notes

If you decide to start the process of addressing the financial costs and burdens of aging with affordable Long-Term Care Insurance, there will be a tremendous amount of time and effort that will occur behind the scenes. Please take the process seriously by:

  1. Returning the paper copy of the medical release as soon as you receive it
  2. Schedule and complete your interview as soon as possible
  3. If there is an issue with your medical records, you may be asked to call your doctor’s office to expedite the process
  4. On occasion we may email or call you for information, a quick response will be appreciated and help in the speed of a decision
  5. Asking any question you may have at any time … your questions are important
  6. Remembering that Matt McCann works with all the major companies. We have shopped the market based on your age, health, and family history. If you have concerns about the company selected be sure to ask
  7. Schedule a review of your new Long-Term Care Policy as soon as you can. The return of paperwork is time sensitive

We also ask if you know anyone, family, friends, or coworkers who would benefit from learning about Long-Term Care Planning that you share our website and contact information. Be sure to ask them to mention your name so we can thank you appropriately.

Long-Term Care will impact you, your family, your savings, and your lifestyle. The cost of care is high and the burden on family members is tremendous. A Long-Term Care Policy makes an extended care event easier on loved ones and easier on your pocketbook. Even a small policy can provide big peace-of-mind.

Long-Term Care Insurance is Easy and Affordable Asset Protection. Matt and his team will make the process as easy as possible so you can have outstanding coverage and the best value.