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What is Long-Term Care Insurance?

Protection When You Need It Most

Long-term care involves a variety of services designed to meet a person's health or personal care needs when they can no longer perform everyday activities on their own. Long-term care insurance is designed to provide financial assistance for individuals who require extended assistance with activities of daily living (ADLs) due to illness, injury, cognitive impairment, or the natural process of aging. The costs for long-term care are generally substantial, and standard medical insurance doesn’t cover it, which is why many people choose to apply for long-term care insurance.

Who Needs Long-Term Care Insurance?

Many people will need long-term care at some point. However, it can be difficult to predict how much or what type of care a person might need—this is why someone might look into long-term care insurance.

The need for long-term care can arise suddenly, such as after a heart attack or stroke. More often, however, the need for long-term care develops gradually. People require more care as they get older and frailer or as a serious, ongoing illness or health condition gets worse. While a variety of factors can go into when you might need to purchase long-term care insurance, the American Association for Long-Term Care Insurance says the best age to buy long-term care insurance is in your mid-50s.

What is Long-Term Care Planning?

The best time to think about long-term care is before you need it. Planning for the possibility of long-term care gives you and your family time to learn about the long-term care insurance and services available to you, what they cost and what disqualifies you from long-term care insurance. It also allows you to make important decisions while you are still able.

Begin by thinking about what would happen if you became seriously ill or disabled. Talk with your family, friends, and lawyer about who would provide care if you needed help for a long time and what kind of care you would want.

Then think about location. Most people prefer to stay in their own homes for as long as they can. However, living at home as you age requires careful consideration and planning. There may come a time when it's no longer safe or comfortable to live alone. Be realistic and plan to revisit the decision as your needs change over time.

How Much Does Long-Term Care Cost?

While the cost of long-term care varies by facility and by where you live, it's safe to say the cost is considerable. Long-term care costs range from around $20,000 per year for adult day care to over $105,000 per year for a private room in a nursing home. This kind of expense can quickly deplete your nest egg, which is why long-term care insurance is such an important coverage to consider.

What Are My Long-Term Care Insurance Options?

There are traditional long-term care policies, which provide coverage for a specific period of time and offer a set daily benefit amount. There are also hybrid policies that combine long-term care benefits with life insurance or annuities. Each type of long-term care insurance policy has its pros and cons, so it's important to carefully review your options and talk with a financial professional before making a decision.

Is Long-Term Care Insurance for Me?

Whether you should buy a long-term care insurance policy will depend on your age, health status, overall retirement goals, income, and assets. There are also a range of factors for what disqualifies you from long-term care insurance. If your only source of income is a Social Security benefit or supplemental security income (SSI), long-term care insurance might not be a good option for you, since you may not be able to afford the premium. On the other hand, if you have a lot of assets but don’t want to use them to pay for long-term care, you may want to buy a long-term care insurance policy.

When considering whether or not long-term care insurance might work for you, consider the following questions:

  • What are my options for long-term care insurance?
  • What kind of care does long-term care insurance cover?
  • What kind of long-term care do I need?
  • How much long-term care insurance do I need?
  • When should I buy long-term care insurance?
  • What disqualifies me from long-term care insurance?

What Disqualifies Me From Long-Term Care Insurance?

While long-term care insurance can be a valuable resource for easing anxiety about the future and reducing the financial burden of long-term care, not everyone is eligible to obtain this coverage. It's important to understand what disqualifies you from long-term care insurance and determine if you might be impacted by any of them before seeking coverage.

Pre-Existing Health Conditions

One of the primary factors that disqualifies people from long-term care insurance is the presence of certain pre-existing health conditions. Insurance providers often assess an applicant's health status before approving coverage. Conditions such as advanced Alzheimer's disease, Parkinson’s disease, certain types of cancer, or other severe health issues may lead to disqualification. Insurance companies have varying guidelines regarding what pre-existing conditions they consider disqualifying, so it's vital to review each insurer's specific requirements before pursuing long-term care insurance coverage.

Age

Age is another factor that often disqualifies people from long-term care insurance. Typically, insurance providers are more likely to approve coverage for younger applicants in better health. As individuals age, the risk of developing health issues increases, making it more difficult to secure long-term care insurance.


There's no specific age at which disqualification becomes automatic–although many insurers cut off around 80 or 85–but it's generally more challenging to obtain coverage as you get older.

Existing Disabilities or Cognitive Impairments

If an applicant already has a disability that requires long-term care or exhibits signs of severe cognitive decline, insurance companies may consider them high-risk. This often disqualifies them from long-term care insurance. Mild cognitive impairments or less functionally-impairing disabilities may not necessarily disqualify an individual from long-term care insurance, but they could lead to higher premiums.

Terminal Illness

Long-term care insurance is typically designed for individuals who have difficulty performing basic activities of daily living: this does not include end-of-life care. Because of this, those with terminal illnesses may not be eligible for long-term care insurance.

History of Substance Abuse

A history of substance abuse, particularly drug or alcohol addiction, disqualifies people from long-term care insurance. Insurance providers may view individuals with a history of substance abuse as having a higher risk of needing long-term care due to associated health problems. This can result in either disqualification or significantly higher premiums.

Criminal History

If crimes appear on your personal record–especially if they are felonies–insurance companies may refuse to provide you with long-term care coverage.

Limited Financial Resources

Some individuals may be disqualified from obtaining long-term care insurance if they cannot afford the premiums. Long-term care insurance can be expensive, and insurance providers will always assess an applicant's ability to pay the premiums. If an applicant's financial resources are limited, they may not be approved for coverage or may be limited to policies with lower benefit amounts.

Failure to Disclose Relevant Information

Honesty is crucial during the application process for long-term care insurance. If an applicant fails to disclose relevant health information or provides false information, they may not only be disqualified from obtaining coverage but could also face legal consequences. Be transparent and provide accurate information during the application process.

Ineligibility Due to Policy Exclusions

Even if you meet the general criteria for long-term care insurance, it's crucial to carefully review the terms and conditions of the policy. Some policies may have specific exclusions, such as not covering certain pre-existing conditions or health issues related to risky activities. Understanding these policy exclusions is essential to avoid what disqualifies you from long-term care insurance when you need the coverage the most.

Finding the Long-Term Care Insurance for You

Not every insurance provider will have the same criteria for what disqualifies people from long-term care insurance. When seeking out coverage, it’s important to do thorough research and consult with multiple companies before deciding. Thoroughly review the policy terms and conditions before applying for anything.

It can be helpful to work with a knowledgeable professional to find the best long-term care insurance option for your specific needs and circumstances. They can also help you thoroughly consider what disqualifies you from long-term care insurance and resolve any potential issues so you can get coverage when you need it.

Totus Wealth Management can help you plan and apply for long-term care insurance. Our comprehensive guidance considers the totality of your financial life so you can find the best option for you. We’re here to help you navigate the complexities of life so you can live the life you can imagine.

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Meet John Wheeler, our seasoned Executive Senior Partner and Certified Financial Planner at Totus Wealth Management, LLC and Totus Insurance Agency, LLC. With over five decades of expertise in long-term insurance solutions, John holds multiple prestigious designations like CFP, CLU, ChFC, CLTC® and more. His passion lies in crafting personalized strategies to ensure clients' long-term financial security. Contact John today to benefit from his extensive experience and commitment to effective, non-conflicted financial planning.