The average age of the population in the United States has become increasingly older over the last several years. As a result, the need for reliable long-term care has never been higher, even for those who may need disability-related care not necessarily related to age.
To help pay for long-term care services such as in-home medical care, assisted living care, adult day care, or nursing homes, most Americans choose to enroll in a long-term care insurance plan. Unfortunately, when it becomes time to purchase a policy, many Americans find that their application is denied.
Common Reasons Why People Are Disqualified for Long-Term Care Insurance
Applying for long-term care insurance can be frustrating because there is often a short window of time between when a person starts displaying a need for long-term care and when their condition or age has progressed to the point of becoming ineligible for long-term care insurance. For example, to apply for long-term care insurance, you will need to have a letter written by an approved medical professional that you (or a loved one) are unable to perform at least two activities for daily living (also known as ADLs), such as bathing, cooking or eating, or walking without assistance.
However, there are situations where you or your loved one may already be displaying such a great need for long-term care that an insurance representative may deny your application. This is because the insurance company is looking for the best deal; their ideal candidates are less likely to need expensive care because they will not have to pay expensive medical bills. As a result, many of the reasons that qualify you for long-term care insurance may also disqualify you.
You Have Met the Age Cut-Off
For age-related long-term care insurance, the idea is to lock in your policy as soon as possible. The most affordable rates are typically for individuals 50 years and younger while the most expensive rates are for individuals 70 years or older. However, once you approach your 80s, you run the risk of not receiving coverage at all if you have not already purchased a policy.
In these cases, you may be able to receive long-term care through health insurance, though you may have other options available through an insurance dispute lawyer.
You Recently Had Surgery or Were Hospitalized
As a general rule, if you are already experiencing expensive medical bills, your eligibility for long-term care insurance is going to reflect this. This means that individuals who have undergone expensive procedures such as surgery or hospitalization may not be able to secure a long-term care policy, even if they meet the requirements for ADLs.
You Have a History of Substance Abuse or Criminal Activity
The insurance policy is looking to reduce the risk of paying as much as possible. If you or a loved one has a criminal record or history of substance abuse, they may classify this as a risk on your application.
You Have a Pre-Existing Condition
Even if you have not necessarily paid for an expensive procedure, if you have been diagnosed with a pre-existing condition that will likely need expensive care in the future, your long-term care application may be denied. Pre-existing conditions that will disqualify you from securing a long-term care policy depend on the insurance company, but they often conditions such as Alzheimer’s, dementia, or even non-age-related conditions such as bipolar or schizophrenia, Parkinson’s, spinal or head injuries, mid to advanced MS, cancer, lupus, terminal illnesses, and many others.
Further, if the long-term care insurance company finds that you had a pre-existing condition before you purchased a policy (or even accuses you of doing so with no basis), they may deny you coverage even if they have already accepted your application. The insurance company you apply to will likely have information regarding pre-existing conditions listed on their website.
What Can You Do if You Were Disqualified for Long-Term Care Insurance?
If you find the process of applying for long-term care insurance confusing and demoralizing, you are not alone. Many insurance companies purposefully keep their policies and application processes confusing so that they can trick people into paying for a policy without having to honor the agreement later on. They may also unfairly deny a person’s application even if they meet eligibility because they anticipate higher medical bills.
This is not only unethical, but depending on the circumstances, it may also be illegal. If you are having repeated issues with your long-term care insurance application, a consultation with a long-term care insurance denials lawyer can help resolve your issue.
Short-Term Care Insurance vs. Long-Term Care Insurance
If your long-term care application is denied and is not able to be resolved with a lawyer, another option for many individuals is short-term care insurance. Short-term care insurance is very similar to long-term care insurance, but the duration of the policy is usually much shorter (typically only a year). Because of this, the eligibility requirements are much more reasonable and the policy is usually more affordable.
Short-term care insurance typically allows policyholders to receive practically all the same care that they would have received through long-term care insurance, including in-home medical care, assisted living care, nursing home stays, and rehabilitation. If you are interested in short-term care insurance as an alternative to long-term care insurance, we can help you compare the policies to see if it is the right fit for your specific needs.
Long-Term Care Insurance Calculator
Long-term care insurance calculators can be a helpful tool for determining your eligibility for long-term care insurance, comparing policy plans, and determining the cost of long-term insurance policies. Most long-term insurance companies will have their own version of a long-term care insurance calculator located on their website, but keep in mind that many only provide estimates and your eligibility or policy costs may differ significantly from the information you receive online. When in doubt talk to the insurance company directly or have your lawyer do so on your behalf.
Long-Term Care Insurance FAQ
Here are some of the questions we receive most often from those who are unsure about how long-term care insurance works. If you have been unfairly disqualified from a long-term care insurance plan, a lawyer can help you.
What Is Long-Term Care Insurance?
Long-term care insurance is a type of insurance that offers coverage for a range of services for individuals who struggle with activities of daily living (or ADLs for short). ADLs that enrollees may need help with include:
- Bathing
- Getting dressed
- Cooking or eating
- Cleaning
- Mobility or transportation
Long-term care insurance policies are commonly purchased by seniors or their families, but they may also be ideal for individuals who have disabilities and need help with any of the activities listed above.
What Does Long-Term Care Insurance Cover?
Long-term care insurance benefits may include one or all of the following:
- Nursing home or assisted living
- In-home medical care or rehabilitation
- Transportation
- Adult daycare
- Medical supplies such as wheelchairs or walkers
- Medication or medical procedures
- Doctor’s appointments
- Emergency care
Keep in mind that all long-term care insurance policies are different from one another so it is always a good idea to make sure your specific policy represents your individual needs.
What Is Hybrid Long-Term Care Insurance?
Long-term care insurance is sometimes combined with a life insurance policy known as a hybrid long-term care insurance policy, to not only provide long-term care to individuals who require in-home care or assisted living services but also provide financial help to their families who care for them upon the policyholder’s death. Unlike a traditional long-term care insurance policy, a hybrid long-term care insurance policy’s premium is paid upfront and is fixed throughout the duration of the policy. While the policyholder is alive, they are eligible to use their coverage to pay for long-term care; however, depending on how much coverage they use, the remainder of the premium can be paid out to their beneficiaries upon their passing.
Of course, it is always good to discuss your estate planning and health insurance options with your lawyer as there may be disadvantages to consider with a hybrid long-term care insurance policy such as higher initial costs and less coverage compared to a traditional policy.
Is Long-Term Care Insurance Worth Getting?
For many people, yes. Nearly 8 million people purchase a long-term care policy every year, and that number is projected to increase significantly over the next several years.
That said, there may be alternative options that are more affordable and are more aligned with your long-term care planning and estate planning goals. A consultation with a lawyer who specializes in these areas is typically a good place to start to understand if long-term care insurance is right for you.
When Should You Buy Long-Term Care Insurance?
As early as possible. One of the most common reasons that long-term care insurance applications are denied is because a person reaches the age limit on many insurance company’s policies. Applying earlier also means that you generally pay less if you need care earlier than expected, and rates typically do not go up until a person reaches their 60s and 70s.
How Much Is Long-Term Care Insurance?
It depends on your age, gender, care needs, where you are geographically located, and the insurance company that issues your policy. On average, you can expect annual costs between $900 to $6,000 or more.
Is Long-Term Care Insurance Tax-Deductible?
The IRS does allow medical expense deductions if they exceed 7.5% of your adjusted gross income (AGI). You can take utilize these deductions by filling out Form 1040, Schedule A. However, there are limits when it comes to deducting long-term care insurance costs based on your age.
Below are the 2025 limits for long-term care insurance deductions along with the corresponding age groups:
- Age 40 or under: $470
- Age 41 to 50: $880
- Age 51 to 60: $1,760
- Age 61 to 70: $4,710
- Age 71 and over: $5,880
Talk to an Insurance Dispute Lawyer if You Were Unfairly Disqualified for Long-Term Care Coverage
It is no secret that the insurance industry is notorious for taking advantage of people, and seniors and individuals with disabilities are particularly vulnerable to some of the predatory methods that many insurance companies employ. We at Wallace Law believe in protecting our elders and other Wisconsinites in their search for long-term care. Whether you are having trouble with a denied claim or getting coverage, or simply have a question about long-term care insurance, our team is available to take your call 24 hours a day and can help you recover your settlement and even seek damages for your trouble.
Contact us today for a free consultation.
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