LTC Insurance Underwriting
LTC insurance underwriting has gotten significantly stricter over the past decade. Understanding the process and your approval odds can help you plan ahead — before it's too late.
How LTC Underwriting Differs
Long Term Care Insurance qualification is different from life and health insurance. In addition to physical health, health history, lifestyle, and occupation, LTC underwriters also evaluate current cognitive health. Cognitive disorders like memory loss and dementia are major contributors to nursing home admissions and insurance claims.
Most carriers no longer require a physical exam. Instead, they use phone interviews, review your prescription drug history, and may order medical records. You should also expect a cognitive assessment where a nurse asks memory and logic-related questions.
Application
Medical questionnaire and health history
Phone Interview
Cognitive assessment and health review
Records Review
Prescription history and medical records
Decision
Approval, rated, or declined
Denial Rates Are Rising
Based on LTC Tree's database of nearly 20,000 cases, denial rates have increased dramatically across all age groups. The data is clear: the longer you wait, the harder it becomes to qualify.
| Age of Applicant | 2010 Denial Rate | Current Denial Rate | Change |
|---|---|---|---|
| Under 50 | 9.5% | 18.75% | +97% |
| 50 to 59 | 14.0% | ~38% | +171% |
| 60 to 69 | 23.0% | ~51% | +72% |
| 70 to 79 | 45.0% | 53.0% | +18% |
People in their 50sare now approved only 62% of the time — down from 85% in 2010. People in their 60s are denied about 51% of the time. The advice to “wait until age 60” has expired.
Health Conditions & Approval
Typically Disqualifying
- Alzheimer's disease or dementia diagnosis
- Parkinson's disease, Multiple Sclerosis, or ALS
- Insulin-dependent diabetes
- Controlled bipolar disorder
- Recent stroke
- Active cancer treatment
- Chronic back/joint pain requiring narcotic painkillers
- Already needing long-term care at time of application
Typically Approvable
- Controlled high blood pressure
- High cholesterol (managed)
- Well-managed Type 2 diabetes without complications
- Cancer survivors (1+ year, varies by type)
- History of minor surgeries
- Mild, managed conditions without complications
Each carrier has different underwriting standards. As independent brokers, we know which carriers are more lenient for specific conditions.
Why Underwriting Has Gotten Stricter
In the 1990s and early 2000s, underwriting was far more lenient. Insurance companies approved riskier applicants because high interest rates allowed them to offset claims with investment returns. When interest rates dropped, those high-risk approvals led to massive claim costs.
The result: higher premiums on existing policies and much stricter underwriting in today's market. Companies now carefully screen applicants because approving too many higher-risk people causes claims that lead to rate increases for everyone.
The bottom line: It is actually beneficial to buy from a company that does a thorough job in underwriting. Better underwriting means a healthier risk pool, which means more stable premiums over time.
Group vs. Individual Underwriting
Group Plans
- • More liberal underwriting (accepts conditions individual plans deny)
- • Healthy applicants subsidize unhealthy ones in the same pool
- • Home care often capped at 50-75% instead of 100%
- • Limited inflation protection options
- • Higher premiums for healthy individuals
Individual Plans
- • Lower premiums for healthy individuals
- • Full 100% home care coverage from top carriers
- • Better inflation protection options
- • Up to 40% spousal/partner discounts
- • 10-20% preferred health discounts
The verdict: For healthy individuals, individual policies offer superior value. Group plans may be the only option for those with major health problems who cannot qualify individually.
Tips for Getting Approved
Apply Early
As soon as you're 45+ with assets to protect and in good health, begin the process. The longer you wait, the lower your chances.
Maintain Your Health
Insurance companies are tightening standards. Staying healthy is the key to being accepted — and to staying independent longer.
Work With a Specialist
Approval chances vary by carrier. An LTC specialist knows which companies are more lenient for your specific conditions.
Don't Wait Until 60
The old advice to wait until 60 has expired. People in their 60s now face a ~51% denial rate. Buy while you're healthy.
Consider Hybrid Alternatives
Hybrid life/LTC and annuity products often have more lenient underwriting than traditional LTC policies.
Be Honest on Your Application
Insurers verify everything through prescription databases and medical records. Dishonesty leads to claim denials later.
Not Sure If You'll Qualify?
With data from over 45,000 clients since 2007, we have excellent statistics on accept/decline rates for all major carriers. We can pre-screen your health before submitting an application.