What Disqualifies From Long-Term Care Insurance?

Disqualifications from long-term care insurance include pre-existing conditions, cognitive impairments, and certain medical conditions such as alzheimer’s. In order to obtain proper long-term care insurance, it is vital to understand what disqualifies an individual from receiving coverage.

Long-term care insurance provides assistance for individuals who are unable to perform daily living activities such as eating, bathing, and dressing themselves due to injury, illness, or cognitive impairment. It is a wise investment for those who are looking for peace of mind and to secure their future health care costs.

Despite that, there are several factors that can disqualify an individual from receiving long-term care insurance coverage. Pre-existing conditions, cognitive impairments, and certain medical conditions such as alzheimer’s are a few of the most common disqualifications. In this article, we will explore in detail what disqualifies an individual from receiving long-term care insurance.

Understanding Long-Term Care Insurance

Definition Of Long-Term Care Insurance

Long-term care insurance is a type of insurance policy that helps individuals cover the costs associated with long-term care services. Long-term care refers to assisting with everyday activities such as bathing, dressing, eating, and other daily tasks. While medicare and regular health insurance do not cover long-term care services, long-term care insurance does.

Benefits Of Long-Term Care Insurance

Long-term care insurance offers several benefits to policyholders. Some of the benefits include:

  • Peace of mind: Long-term care insurance helps individuals prepare for any potential long-term care needs that may arise.
  • Cost-effective: Depending on the policyholder’s age, the premiums paid towards long-term care insurance may be more cost-effective than paying for long-term care services out of pocket.
  • Choice of care: Long-term care insurance allows policyholders to choose the type of care they want, whether that be a nursing home, an assisted living facility, or in-home care.

What Is Covered In Long-Term Care Insurance

Long-term care insurance covers a variety of services and expenses related to long-term care. Some of the things that are typically covered include:

  • Nursing home care: Long-term care insurance covers the cost of staying in a nursing home, including room and board, medical care, and other related expenses.
  • Assisted living facilities: Long-term care insurance may also cover the cost of living in an assisted living facility, which is a less intensive type of care than a nursing home.
  • In-home care: Long-term care insurance may cover the cost of in-home care services, such as a home health aide, who helps with everyday tasks like bathing, dressing, and eating.
  • Memory care: Some long-term care insurance policies cover the cost of memory care services for individuals with conditions like alzheimer’s or dementia.

It is important to note that not all long-term care insurance policies are created equal. It’s essential to read the policy carefully and understand what it does and does not cover before purchasing. Additionally, some policies may have limitations on coverage or requirements for triggering benefits.

Factors That Affect Eligibility For Long-Term Care Insurance

Long-term care insurance is an excellent way to help cover the costs of long-term care. However, not everyone is eligible to receive this type of insurance. Several factors may disqualify a person from obtaining long-term care insurance. In this section, we will discuss some of the most critical considerations that may affect a person’s eligibility for long-term care insurance.

Age Requirements For Long-Term Care Insurance

There are no age limits for purchasing long-term care insurance. However, many insurance providers set minimum age benchmarks that individuals must meet to be eligible for their policies. The age requirement varies depending on the insurance carrier. For example, some companies require that applicants be at least 45 years old to apply, while others set the minimum age at 65.

Pre-Existing Health Conditions That Might Disqualify You

When applying for long-term care insurance, insurance providers evaluate an applicant’s health. Pre-existing health conditions are one of the factors that may affect a person’s eligibility for long-term care insurance. Some of the common health conditions that could disqualify a person from getting long-term care insurance are:

  • Dementia or alzheimer’s disease
  • Stroke
  • Parkinson’s disease
  • Cancer
  • Multiple sclerosis
  • Hiv/aids

Medical History And Genetic Predispositions

Another critical factor that affects eligibility for long-term care insurance is an applicant’s medical history. Insurance companies evaluate an applicant’s medical history and genetic predispositions before approving their application. An applicant may be disqualified from the policy if they:

  • Have a history of substance abuse or alcoholism
  • Have a history of mental illness
  • Have a history of heart disease or cardiovascular disease
  • Have a family history of alzheimer’s disease or other chronic illnesses

Several factors may affect a person’s eligibility for long-term care insurance. Age requirements, pre-existing health conditions, and medical history are some of the critical considerations that insurance providers evaluate during the application process. It is essential to understand these factors and check with the insurance carrier before applying for long-term care insurance.

Specific Reasons You May Be Disqualified For Long-Term Care Insurance

Long-term care insurance is a type of health insurance that provides coverage for people who need assistance with daily tasks such as bathing, dressing and eating. Although it’s a great option for many individuals, there are specific reasons why you may be disqualified from getting long-term care insurance.

Inability To Perform Daily Living Activities

If you have difficulty performing activities of daily living (adls) such as bathing, dressing, toileting and eating, you may be disqualified from getting long-term care insurance. Insurance companies may not cover individuals who already have problems performing adls, as they are considered high-risk clients.

Some of the adls include:

  • Bathing or getting in and out of the shower or bathtub
  • Dressing or undressing
  • Using the toilet or commode
  • Transferring or getting in or out of bed or a chair
  • Eating or feeding oneself

Cognitive Impairments And Dementia

Individuals who have cognitive impairments or dementia may also be disqualified from getting long-term care insurance. These conditions may include alzheimer’s disease, parkinson’s disease or any other form of dementia that affect the brain.

Here are some symptoms of cognitive impairments and dementia:

  • Memory loss
  • Confusion and disorientation
  • Impaired judgement and reasoning
  • Difficulty with language and communication
  • Behavioral changes

Terminal Illness

People with terminal illnesses are also disqualified from getting long-term care insurance. Terminal illness is marked by a progressive and incurable condition that will ultimately lead to death. Insurance companies will not provide coverage for these individuals because they believe they will not see a return on their investment.

While it may be discouraging to be disqualified from getting long-term care insurance, there are still options available. Consider discussing your situation with an insurance agent who can help you explore other insurance options. By planning ahead, you can ensure that you have the right coverage to meet your long-term care needs.

Frequently Asked Questions For What Disqualifies From Long-Term Care Insurance?

What Disqualifies Me From Long-Term Care Insurance?

Long-term care insurance isn’t guaranteed, and pre-existing conditions may disqualify you.

What Are Some Common Disqualifying Factors?

Common disqualifying factors are older age, poor health, pre-existing medical conditions, and disabilities.

Can I Qualify For Long-Term Care Insurance If I Have A Chronic Condition?

If you have a chronic condition, you can still qualify for long-term care insurance, depending on the severity and type of condition.

Can I Get Insurance Coverage For My Pre-Existing Condition?

It’s possible to get insurance coverage for pre-existing conditions with long-term care insurance, but it may come at a higher cost.

Why Should I Consider Long-Term Care Insurance?

Long-term care insurance can provide financial security and peace of mind, ensuring that you receive the care you need in your later years.


Long-term care insurance is a vital component of our financial planning for the future. The thought of not being able to take care of ourselves or of burdening our loved ones is a fear many of us share. That being said, it is important to understand what disqualifies us from being approved for long-term care insurance.

While some conditions are outside of our control, such as age and pre-existing medical conditions, there are preventative measures we can take to improve our chances of eligibility. Maintaining a healthy lifestyle and taking care of our bodies is a great start.

Reviewing policies and seeking the guidance of a financial advisor can also help us determine our options. It is important that we plan accordingly and educate ourselves on the benefits of long-term care insurance, as it can assist us in our time of need and provide peace of mind for ourselves and our loved ones.