What disqualifies you from long-term care insurance is almost always one of four things: a diagnosis that points toward progressive decline, already needing help with daily tasks, being outside the age or weight range insurers will consider, or a medication and substance-use history that signals high future risk. Insurers screen every applicant through medical underwriting, and the same condition can be a flat rejection at one carrier and workable at another, so knowing where the hard lines fall matters before you apply.
Conditions That Trigger Automatic Denial
Certain diagnoses close the door at virtually every carrier. If your medical record shows any of these, most insurers will not consider your application:
- Alzheimer’s disease or any other dementia, including documented early-stage cognitive impairment
- Parkinson’s disease
- ALS (Lou Gehrig’s disease)
- Multiple sclerosis
- HIV or AIDS
- Kidney failure requiring dialysis
- Stroke or a history of TIAs (mini-strokes)
- Spinal cord injuries causing significant impairment
The common thread is a high probability of eventually needing long-term care. Insurers price risk decades into the future, so a diagnosis that points toward progressive decline is an automatic disqualifier. A recent heart attack or major surgery will also lead to a denial or a postponement until the insurer can evaluate your recovery.
Conditions Reviewed Case by Case
Plenty of health issues fall into a gray zone. Severity, how well you’re managing the condition, and whether complications have developed all matter, and this is where most applications are won or lost.
Diabetes
Type 2 diabetes controlled with diet, exercise, and oral medication is generally insurable. Type 1 diabetes is harder but not impossible; fewer carriers will consider it. Underwriters look at your A1C level (most want it at 8.5 or below), daily insulin use (under 70 units is a common threshold), and whether you have complications like neuropathy, retinopathy, or kidney problems. Any of those complications will usually end the application.
Cancer History
Whether a cancer history disqualifies you depends on the type, stage, and how long ago you finished treatment. Someone five years out from early-stage skin cancer sits in a very different place than someone recently treated for pancreatic cancer. Insurers typically impose waiting periods after recovery and want to see clean follow-up results before approving coverage.
Depression, Anxiety, and Certain Psychiatric Medications
A depression or anxiety diagnosis is not automatically disqualifying, but underwriters read the details closely. Long-standing, stable conditions managed with a consistent medication dose and no periods of disability are generally acceptable. Red flags include a diagnosis within the last three years, multiple medication changes, psychiatric hospitalization, late-life onset, or a substance abuse history alongside mental health treatment. Many carriers send psychiatric cases to an underwriting committee before declining.
A few medications, though, trigger near-automatic denial regardless of how stable you are: lithium, Abilify (aripiprazole), Seroquel (quetiapine), Zyprexa (olanzapine), Lamictal (lamotrigine), Latuda (lurasidone), and Trintellix (vortioxetine). These are typically associated with bipolar disorder or more severe psychiatric conditions, and most underwriters won’t proceed if they appear in your prescription history.
Weight, Prescriptions, and Substance Use
BMI Cutoffs
Weight matters more than most applicants expect. A national study of long-term care insurance underwriting found that applicants with a BMI above 40, which for someone 5’8″ means roughly 263 pounds, saw approval rates drop by nearly 27 percentage points compared with applicants in the normal-to-overweight range. Being significantly underweight, a BMI below 18, was almost as damaging, cutting approval by about 17 points.1National Institutes of Health. Medical Underwriting in Long-Term Care Insurance Most carriers underwrite comfortably in the BMI 18 to 35 range, though the exact cutoffs vary.
Prescription Drug Screening
Insurers check the state prescription drug monitoring program to verify what medications you’re actually taking, then compare that record against what you disclosed on your application. Beyond the psychiatric medications above, prescriptions tied to active alcoholism treatment (such as naltrexone, Antabuse, or Campral) are strong grounds for denial. Combinations get flagged too. Diabetes paired with heavy alcohol use, or obesity combined with smoking and heavy drinking, can push an otherwise approvable applicant into uninsurable territory.
Alcohol and Drug History
Active substance abuse is a firm disqualifier, but recovery counts for a lot. Sober and in good health for more than five years with no relapses generally earns standard or even preferred rates. Three to five years of stable recovery can still get you coverage at somewhat higher rates. Within three years of active use, or with any relapse history or liver disease, expect a decline. Substance abuse history combined with depression is particularly hard, and many underwriters treat it as uninsurable even after years of sobriety.
Already Needing Help With Daily Activities
Long-term care insurance pays for future care needs, not current ones. If you already need hands-on help with basic daily tasks at the time you apply, you’re almost certainly going to be denied. The industry measures functional independence through six activities of daily living: bathing, dressing, eating, toileting, transferring between a bed and chair or walking, and continence.
For claims purposes, most policies pay benefits once you can’t perform at least two of the six without substantial assistance. For underwriting purposes the bar is higher. Needing help with even one ADL at the time of application is a serious red flag, and needing help with two or more is effectively disqualifying. Reliance on oxygen, ongoing physical therapy, or recent hospitalizations tells underwriters that care needs may be imminent.
Age Cutoffs
Most traditional long-term care insurance policies are available to applicants between 18 and 79. After 80, options shrink sharply. A handful of hybrid policies that combine life insurance with a long-term care rider will consider applicants up to age 85, but those are the exception. Beyond 85, coverage is essentially unavailable.
Even within the eligible range, the economics shift fast. A couple both aged 55 can expect to pay around $2,080 per year combined for a policy with roughly $165,000 in initial benefits. Wait until 65, and the same coverage runs about $3,750 annually. Underwriting also tightens with age: applicants in their 70s face cognitive screening, more scrutiny of medical records, and the real possibility that a condition acceptable at 55 now tips into denial.
One detail worth knowing at the edges: many insurers use “age nearest birthday” rather than your actual age to set premiums and eligibility. If you’re six months from your next birthday, the insurer may already count you at the older age. Some carriers allow backdating a policy by up to six months to lock in a younger age class, which can matter if you’re approaching a cutoff.
The Cognitive Screening
If you’re 70 or older, or if your medical records show any hint of cognitive concerns, expect a cognitive assessment as part of underwriting. It often happens during a phone interview or in-person visit and catches applicants off guard.
The core of the test is usually delayed word recall. You’ll be given about ten words, asked to use them in sentences, and after a five-to-ten-minute gap, asked to remember as many as possible. Recalling at least six words is a common passing threshold. You may also be asked to draw a clock face showing a specific time, which tests spatial awareness and planning. The screening isn’t designed to trip up healthy people; it looks for impairment beyond normal age-related forgetfulness. But if you’ve ever mentioned memory concerns to your doctor, that note in your record will almost certainly trigger the test regardless of your age.
Misrepresentation and Prior Denials
Applications require full disclosure of your health history, current conditions, medications, and any previous insurance denials. Insurers verify everything. They pull medical records from the past three to five years, check the prescription drug database, and often conduct phone or in-person interviews to cross-reference what you reported.
Discrepancies get applications denied. Intentional misrepresentation is treated far more harshly than an honest oversight and can produce a flag in industry databases that other insurers can see. The worst outcome isn’t a denial at the front end; it’s having a policy rescinded years later when you file a claim, after you’ve paid premiums for a decade and actually need the coverage.
A prior denial from one company can also cause automatic declines elsewhere. Insurers share information, and many applications ask whether you’ve previously been declined for long-term care coverage. A “yes” doesn’t guarantee rejection, but it works against you. Underwriting guidelines vary between carriers, so a condition that disqualifies you at one company may be acceptable at another, particularly if you work with a broker who knows which carriers are flexible on specific conditions.
Financial Fit
Insurers also look at whether you can realistically afford premiums for the long haul. A policy is useless if you buy it at 60 and can’t keep paying at 75. Underwriters review income, savings, and retirement assets to gauge sustainability. If they conclude you’re likely to drop the policy under financial strain, they may decline the application.
The reverse can also be true in a practical sense. People with very high net worth may not need the coverage at all, since enough assets to self-fund several years of nursing home care (averaging over $100,000 per year in many areas) can make the premiums a poor trade. People with very limited resources qualify for Medicaid, which covers long-term care once strict income and asset limits are met.
If You’re Denied, What Still Works
A denial for traditional long-term care insurance doesn’t close every door. Several alternatives use less rigorous underwriting.
- Hybrid life/LTC policies combine life insurance with a long-term care benefit rider. Underwriting is generally less intensive than for standalone coverage and may not require a medical exam. Alzheimer’s or currently receiving care will still disqualify you, but conditions that stop a traditional application may be acceptable here.
- Short-term care insurance covers care for a limited period, usually up to one year, and often uses a simplified yes/no health questionnaire instead of a full records review. Alzheimer’s and active nursing home care remain disqualifying, but the bar for approval is considerably lower.
- Annuities with LTC riders let you convert a lump sum, typically $50,000 or more, into a vehicle that multiplies your money if you need care. Some medical underwriting applies, but it’s generally easier to qualify for than a standalone policy. The rider activates when a healthcare provider certifies you can’t perform two or more ADLs or have a cognitive impairment.
If you’ve been declined, working with a broker who specializes in long-term care is worth the effort. Each carrier has different underwriting guidelines, and a specialist can steer you toward companies that view your specific condition more favorably, rather than stacking additional denials onto your record.