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What Disqualifies me From Long-term Care Insurance?

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.

Potential Reasons to be Disqualified 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. There are various factors that may disqualify someone from obtaining long-term care insurance, and it's important to understand these factors before seeking coverage.

Pre-Existing Health Conditions

One of the primary factors that may disqualify an individual from obtaining 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 coverage.


Age is another factor that can impact your eligibility for 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 and disqualify them from obtaining long-term care insurance.

Mild cognitive impairments or less functionally-impairing disabilities may not necessarily disqualify an individual, 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, can be a disqualifying factor for 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 disqualification 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 who can and cannot be covered for 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.

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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