The conditions most likely to disqualify you from long-term care insurance are already needing help with daily living, Alzheimer’s or any other cognitive impairment, a progressive neurological disease such as Parkinson’s or multiple sclerosis, a stroke within the past year or two, metastatic cancer, and AIDS (ACL.gov). In a federal survey of the individual market, slightly less than 20% of all applicants were unable to buy a policy because of their health, and the decline rate climbed from 12% for applicants in their 50s to 44% for applicants 80 and over (ASPE, 2009 data).
That second number is the one to sit with. Long-term care insurance is the rare product where the people most motivated to buy it are frequently the people who no longer can, because motivation tends to arrive with a diagnosis, and the diagnosis is what closes the door.
This article lists what disqualifies an applicant outright, what sits in the grey zone, how underwriting actually works, what Florida law says about pre-existing conditions, and what the options are if you have already been declined.
What actually disqualifies you
Every carrier writes its own underwriting manual, so there is no single national list. But the U.S. Administration for Community Living publishes the set of conditions that, across the industry, usually mean an application will not be accepted. Its exact framing is that people with these conditions “may not qualify”, and that “standards vary between different insurance companies.”
| Condition or situation | Why underwriters decline it |
|---|---|
| You currently use long-term care services | The event the policy insures against has already happened |
| You already need help with activities of daily living (bathing, dressing, eating, transferring, toileting, continence) | Same reason: ADL dependence is the benefit trigger, so the claim would start on day one |
| Alzheimer’s disease, or any form of dementia or cognitive dysfunction | Cognitive impairment is the single most expensive and longest-running claim type |
| A progressive neurological condition such as multiple sclerosis or Parkinson’s disease | The course is predictable and it runs toward care |
| A stroke within the past year or two, or a history of strokes | High probability of functional impairment or a second event |
| Metastatic cancer | Cancer that has spread beyond its original site |
| AIDS or AIDS-related complex | Listed by ACL alongside the conditions above |
Source: ACL.gov.
Notice the pattern. These are not conditions that might lead to long-term care. They are conditions where the need for care is either already present or reasonably certain. An insurer cannot sell flood insurance on a house that is already underwater, and the same logic applies here.
The ACL page adds two points that matter more than the list itself. First: “if one company denies you, it is possible that another company will accept you.” Second: if you buy coverage before you develop one of these conditions, the policy covers the care you later need for it. That is the entire argument for applying while you are healthy, and it is why Virginia treats long-term care as a timing decision rather than a product decision.
How many applicants actually get declined?
The only industry-wide federal data on this comes from a study LifePlans prepared for the U.S. Department of Health and Human Services in 2010, using carrier underwriting results from 2009. It is older than we would like, and the market has tightened since, so treat these as a floor rather than a current quote. The shape of the curve is the point.
| Applicant age | Share declined for health reasons (individual market, 2009) |
|---|---|
| Under 45 | 7% |
| 45 to 49 | 9% |
| 50 to 59 | 12% |
| 60 to 64 | 16% |
| 65 to 69 | 22% |
| 70 to 74 | 27% |
| 75 to 79 | 32% |
| 80 and over | 44% |
Source: ASPE, Appendix J, Figure 2.
Two other findings from the same report are worth knowing. The average age of an applicant declined in 2009 was 64, while the average age of a new purchaser was 57. And the reason for a decline changes with age: cognitive impairment accounted for less than 2% of declines under age 60 but more than one in four declines over 70. In the 60-to-69 group, diabetes, endocrine problems, cancer and cardiac conditions were the most prevalent reasons. Over 70, stroke, circulatory, neurological and cardiac problems dominated.
Read that as a map of what the underwriter is looking for at each age, and when.
Does age alone disqualify you?
No. There is no federal rule setting a maximum age for long-term care insurance, and the ACL page does not name one. Each carrier sets its own upper limit for new applications, and that limit is a business decision that can change with a rate filing.
In practice the stated age limit is rarely what stops people. The decline curve above is. By the time an applicant reaches an age where carriers start to say no on age alone, roughly a third to nearly half of applicants are already being declined on health.
The ACL reports that the average age of people buying long-term care insurance today is about 60, and about 50 for policies offered through an employer. That lines up with the federal decline data: the late 50s to early 60s is where the odds of being accepted are still good and the premium is still being priced on a healthy applicant.
Our guide to when to plan for long-term care goes through this window in more detail.
What about diabetes, heart disease or a past cancer?
This is the grey zone, and it is where most real applications live. None of these is on the automatic-decline list, and the federal data shows carriers do issue policies to applicants who have them. What the underwriter is deciding is which rate class you belong in, or whether your particular history falls outside what the carrier will take.
Some general patterns, with the caveat that underwriting standards vary by carrier and by state, and the only answer that counts is the one on your own application:
- Diabetes. Underwriters generally distinguish between diet- or tablet-controlled diabetes and insulin-dependent diabetes, and they look hard for complications involving the kidneys, nerves, eyes or circulation. Well-controlled type 2 diabetes without complications is routinely insurable. Insulin use plus a cardiac history or neuropathy frequently is not.
- Heart disease. A single, treated event some years ago with a clean follow-up reads very differently from recent surgery or an ongoing arrhythmia. Time since the event and current function matter more than the diagnosis itself.
- Cancer. Metastatic cancer is a decline. A cancer that was treated and has stayed in remission for a period the carrier specifies is often insurable, sometimes at a standard rate.
- Osteoporosis, arthritis and joint problems. The federal report flags fractures and musculoskeletal issues as common reasons for decline among applicants under 60. Falls lead to care, and underwriters know it.
- Mental health. The same report found applicants who were not working were roughly twice as likely to have mental health cited as the primary reason for a decline.
If any of these describe you, the practical move is not to assume the answer. It is to have the application pre-screened against two or three carriers’ guidelines before anything is formally submitted, because a formal decline becomes part of the record that the next carrier will ask about.
How long-term care underwriting actually works
People imagine a single medical exam. It is closer to an investigation, and knowing the steps removes most of the surprise.
- The application. A detailed health questionnaire covering diagnoses, medications, hospitalisations, surgeries, and whether you need help with any activity of daily living. Height and weight are rated.
- A prescription history check. Carriers pull your pharmacy record. A medication that treats a condition you did not mention is a common way an application unravels.
- A telephone interview. Usually including a short cognitive screen: delayed word recall, naming, simple arithmetic. For applicants over a carrier-set age this interview is often conducted in person instead.
- Medical records. The carrier requests your attending physician’s notes. Underwriters read them for things the applicant may have forgotten, such as a note about memory complaints or a referral to a neurologist.
- A paramedical exam, sometimes. Depending on age and carrier: blood pressure, blood and urine samples, and occasionally functional tests such as a timed walk or getting up from a chair.
The cognitive screen deserves emphasis. It is the part of underwriting that applicants least expect and most often fail, because early cognitive change is invisible to the person experiencing it. Over age 70, cognitive impairment is the leading reason for a decline in the federal data. A good advisor will tell you honestly whether to apply at all, because a decline on cognitive grounds is not one a second carrier will overlook.
What Florida law says about pre-existing conditions
This is the part a national article cannot tell you, because long-term care insurance is regulated by the state, and Florida’s rules are set in Florida Statute 627.9407.
Three provisions matter if you are applying in Tampa, St. Petersburg, Sarasota or anywhere else in the state:
| Florida rule | What it says |
|---|---|
| Definition of a pre-existing condition | A condition for which medical advice or treatment was recommended by, or received from, a health care provider within the six months before the effective date of coverage (s. 627.9407(4)(a)) |
| Limit on exclusions | A policy may not exclude a loss or confinement caused by a pre-existing condition unless that loss begins within six months after the effective date (s. 627.9407(4)(b)) |
| Free look | You may return an individual long-term care policy within 30 days of delivery and have the premium refunded, for any reason (s. 627.9407(8)) |
In plain terms: once a Florida carrier has accepted you, it cannot reach back years into your medical history to carve out a condition, and it cannot exclude an accepted condition for longer than six months after your policy starts. The underwriting happens up front, in full, which is exactly why the application is as thorough as it is. The carrier gets one look, and the statute makes sure it is only one.
That same up-front structure is why the pre-screening step above matters so much here. In Florida the decision really is made on the day you apply.
One related Florida point: a policy that qualifies under the state’s Partnership program adds asset protection if you ever need Medicaid. We cover how that works in the Florida Long-Term Care Partnership program, and it is underwritten exactly like any other policy, so the same eligibility question applies.
What to do if you have been declined
A decline is a statement about one carrier’s guidelines on one date. It is not a verdict on whether you can be protected. The realistic paths, roughly in order:
Apply to a different carrier. The ACL says this plainly, and the federal data backs it: carriers weight conditions differently. A borderline diabetes or cardiac history can be a decline at one company and a rated-up acceptance at another. This is the first conversation to have, and it should happen before a second formal application goes in.
Consider a hybrid design. Life insurance policies and annuities with long-term care riders use their own underwriting, which is sometimes simpler and sometimes more forgiving on specific conditions than a traditional policy. They are not a loophole: a serious cognitive or neurological diagnosis will be declined there too. But a history that a traditional carrier will not touch is often insurable in a hybrid. Can you use life insurance to pay for long-term care? explains the mechanics. Availability and underwriting vary by state and carrier.
Build a deliberate self-funding plan. If no insured design is available, the honest alternative is to decide now which assets would pay for care, in what order, and what the surviving spouse keeps. Our cost-of-care estimator projects what care in your area could cost by the year you would plausibly need it. The number is usually larger than people expect, and knowing it early is what makes the plan a plan rather than a reaction.
Understand the Medicaid floor. Florida Medicaid long-term care is means-tested and has a look-back period on asset transfers, so last-minute rearranging rarely works the way families hope. Does Medicaid pay for nursing home care in Florida? covers the rules. It is a safety net, and there is no shame in it being the answer, but it narrows where and when care can be received.
What is not on this list: waiting. Every one of these options is easier at 62 than at 68, and none of them is improved by a second diagnosis. Medicare, for the avoidance of doubt, does not change the picture. It covers short-term skilled care after a hospital stay and does not pay for extended custodial care at home, in assisted living or in a nursing home (Medicare.gov).
Why this is a timing question, not a product question
About 70% of people turning 65 will need some type of long-term care in their lifetimes (ACL.gov). Set that beside the decline curve above and the logic closes itself: the need is close to the base case, and the ability to insure against it falls every year.
There is no enrollment deadline for long-term care the way there is for Medicare, and that is the problem. Nothing forces the decision, so it drifts. Then something happens, and the window that had been quietly narrowing is simply closed.
The practical sequence is short:
- Get your number with the cost-of-care estimator, projected to the year you would likely need care rather than today’s price.
- Get an honest read on your insurability before any formal application, against more than one carrier’s guidelines.
- Decide how much of the risk to keep. Self-funding part of it is legitimate. Having the decision made for you by a diagnosis is the outcome to avoid.
Virginia Barausky is Certified in Long-Term Care, and pre-screening applications against carrier guidelines before anything is submitted is a routine part of her practice. If you would like to know where you stand before you apply, schedule a call. There is no cost, and nothing is submitted to any carrier on the first conversation.