What Disqualifies You from Long-Term Care Insurance?

Last Updated: January 12, 2026

Long-term care insurance protects your assets from catastrophic care costs that can exceed $80,000 annually in Houston. But securing coverage isn’t guaranteed—insurers maintain strict eligibility requirements that disqualify nearly half of applicants over age 70. Understanding these disqualification factors helps you apply while you’re still eligible and avoid costly mistakes that trigger automatic denial.

1. Pre-Existing Medical Conditions That Automatically Disqualify You

Insurance companies maintain extensive lists of conditions that result in immediate application denial. If you’ve been diagnosed with Alzheimer’s disease, Parkinson’s disease, ALS, or advanced heart disease, you’ll face automatic disqualification from traditional long-term care policies. Recent cancer diagnoses—particularly within the past 5-10 years—also trigger denials, though the timeframe varies by cancer type and stage.

• Automatic denials: Alzheimer’s, Parkinson’s, ALS, advanced heart disease
• Cancer considerations: Recent diagnoses within 5-10 years typically disqualify
• Timeframe varies: Early-stage cancers with full recovery may qualify sooner

Chronic conditions with complications create problems too. Well-controlled Type 2 diabetes with stable A1C levels under 7.0 may still qualify you for coverage, but you’ll likely pay 15-25% higher premiums than someone without diabetes. However, if your diabetes has caused kidney disease, neuropathy, vision problems, or requires insulin management, most insurers will decline your application outright. The severity and management of your condition matters more than the diagnosis itself.

• Controlled diabetes: A1C under 7.0 qualifies with 15-25% premium increase
• Complications disqualify: Kidney disease, neuropathy, vision loss result in denial
• Management matters: Well-controlled conditions have better approval odds

2. Age-Related Disqualification and Premium Increases

Your age at application dramatically impacts both approval odds and premium costs. According to the American Association for Long-Term Care Insurance, only 12% of applicants in their 40s face denial, compared to 47% of those over 70. Most insurers stop issuing traditional policies entirely between ages 75-80, and some carriers set even earlier cutoffs at age 70.

• Denial rates by age: 12% at age 40s, 47% over age 70
• Policy issuance stops: Most carriers won’t issue policies after age 75-80
• Earlier cutoffs exist: Some insurers stop at age 70

Even if you qualify, waiting costs you significantly. A 55-year-old male pays approximately $950 annually for $165,000 in long-term care benefits. That same policy costs a 65-year-old male $1,700 per year—a 79% premium increase for waiting just 10 years. Each year you delay in your 60s adds 6-8% to your annual premiums, and your approval likelihood decreases as age-related health conditions develop.

• Age 55 cost: $950/year for $165,000 in benefits
• Age 65 cost: $1,700/year for same coverage (79% increase)
• Annual increases: 6-8% premium jump for each year you wait in your 60s

3. How Long Does Underwriting Take for Long-Term Care Insurance?

The underwriting process typically requires 4-8 weeks from application submission to final approval decision. This timeline includes medical record collection from all your healthcare providers, a detailed phone interview covering your health history, and cognitive screening to assess memory and reasoning abilities. Some applicants undergo in-person health assessments conducted by a paramedical examiner.

• Standard timeline: 4-8 weeks from application to approval
• Process includes: Medical records review, phone interview, cognitive screening
• Possible requirement: In-person paramedical health assessment

Complex health histories extend this timeline significantly. If you have multiple chronic conditions, previous surgeries, or incomplete medical records, expect underwriting to take 10-12 weeks or longer. Applicants in their 50s with straightforward health profiles generally receive faster decisions than those in their 70s with extensive medical histories requiring additional insurer review.

• Complex cases: 10-12+ weeks for multiple conditions or incomplete records
• Faster approvals: Age 50s with clean health history (4-6 weeks)
• Slower approvals: Age 70s with extensive medical history (8-12 weeks)

4. Can You Get Long-Term Care Insurance with Diabetes?

Diabetes doesn’t automatically disqualify you, but the type, control level, and presence of complications determine eligibility. Type 2 diabetes that’s well-managed with oral medications, stable A1C results below 7.0, and no complications typically qualifies for coverage. You’ll face higher premiums than non-diabetic applicants—expect rates 15-25% above standard pricing—but coverage remains accessible.

• Type 2 qualifies if: Oral medications only, A1C below 7.0, no complications
• Premium increase: 15-25% above standard rates for diabetics
• Coverage accessible: Well-controlled diabetes doesn’t automatically disqualify

Type 1 diabetes creates more challenges due to the insulin requirement and longer disease duration, though some carriers will consider applicants with excellent long-term control. Diabetes with complications—kidney disease, nerve damage, vision loss, or frequent hypoglycemic episodes—usually results in denial. Insurers review your last 2-3 years of A1C test results, current medication regimen, and any hospitalization history related to diabetes management when making their decision.

• Type 1 challenges: Insulin requirement makes approval harder but possible with excellent control
• Complications disqualify: Kidney disease, neuropathy, vision loss result in denial
• Review period: Last 2-3 years of A1C results and hospitalization history

5. Cognitive Testing Requirements During Application

Every long-term care insurance applicant undergoes cognitive screening, typically conducted during the phone interview portion of underwriting. Insurers test your memory recall by asking you to remember and repeat lists, assess problem-solving through simple math questions, and evaluate orientation by asking about current date, time, and location.

• Memory recall: Remember and repeat word lists or number sequences
• Problem-solving: Simple math questions and reasoning tasks
• Orientation assessment: Current date, time, location awareness

Even mild cognitive impairment detected during these screenings can trigger application denial or premium increases up to 40% above standard rates. Warning signs that concern underwriters include forgetting what day it is, difficulty following multi-step instructions, repeating questions you’ve already asked, or confusion about recent events. If you’re in your 50s or early 60s and experiencing any memory concerns, apply immediately before symptoms progress to levels that disqualify you entirely.

• MCI consequences: Denial or 40% premium increase for mild cognitive impairment
• Red flags: Date confusion, difficulty with instructions, repeating questions
• Apply early: Memory concerns in 50s/60s should prompt immediate application

6. Does Long-Term Care Insurance Cover Dementia?

If you purchase long-term care insurance while cognitively healthy and later develop dementia, your policy will pay benefits once you meet eligibility criteria. Most policies require either inability to perform two or more Activities of Daily Living independently, or a physician’s certification of cognitive impairment requiring substantial supervision to protect your health and safety.

• Coverage applies if: You buy while healthy, develop dementia later
• Benefit triggers: 2+ ADL limitations or physician-certified cognitive impairment
• Supervision requirement: Need substantial supervision for health and safety

However, you cannot buy long-term care insurance after receiving a dementia diagnosis or showing symptoms of cognitive decline during the application process. Any indication of memory problems, confusion, or impaired judgment during underwriting results in automatic denial. This is precisely why purchasing coverage in your 50s—before any cognitive symptoms appear—is critical for protection against dementia care costs that average $84,000-96,000 annually for memory care units in Houston.

• Cannot buy after diagnosis: Dementia diagnosis = automatic disqualification
• Symptoms disqualify: Memory problems or confusion during application trigger denial
• Houston memory care costs: $84,000-96,000/year makes early coverage critical

7. Activities of Daily Living (ADL) Limitations

If you currently require assistance with any of the six Activities of Daily Living—bathing, dressing, toileting, transferring from bed to chair, maintaining continence, or eating—you’re automatically disqualified from purchasing long-term care insurance. These policies cover future care needs, not existing dependency.

• 6 ADLs assessed: Bathing, dressing, toileting, transferring, continence, eating
• Current help disqualifies: Need for assistance with any ADL = automatic denial
• Future coverage only: Policies cover future needs, not existing dependency

Regular use of mobility aids also raises red flags. Full-time wheelchair use, dependence on walkers or multi-pronged canes, oxygen therapy equipment, or having a hospital bed at home typically results in application denial. Temporary use following surgery with expected full recovery generally doesn’t disqualify you, but you’ll need medical documentation proving the condition is short-term with complete independence expected upon recovery.

• Mobility aids disqualify: Full-time wheelchair, walker dependence, oxygen therapy
• Temporary use acceptable: Post-surgery mobility aids with expected full recovery
• Documentation required: Medical proof of short-term condition and recovery timeline

8. Best Long-Term Care Insurance Companies in Texas

Texas residents have access to multiple highly-rated carriers offering competitive long-term care coverage. Mutual of Omaha maintains an AM Best A+ rating and offers particularly competitive pricing for applicants ages 50-65, making them an excellent choice for Houston professionals planning ahead. Transamerica provides flexible benefit period options and strong hybrid policy alternatives combining life insurance with long-term care benefits.

• Mutual of Omaha: AM Best A+, competitive rates for ages 50-65
• Transamerica: Flexible benefit periods, strong hybrid options
• Northwestern Mutual: Premium pricing but exceptional claims service

Northwestern Mutual commands premium pricing but delivers exceptional claims service and financial stability—important considerations for coverage you may not need for 20-30 years. Texas participates in the Long-Term Care Partnership Program, allowing policyholders to protect assets beyond standard Medicaid limits. This means if you exhaust your policy benefits and eventually need Medicaid, you can keep additional assets equal to your policy’s benefit amount—a crucial wealth preservation advantage for affluent Houston families.

• Partnership Program: Protect assets beyond Medicaid limits equal to policy benefits
• Asset protection: Keep additional assets if you exhaust policy and need Medicaid
• Wealth preservation: Critical advantage for affluent Houston families

9. Substance Abuse History and Lifestyle Factors

Current tobacco use increases your premiums by 25-50% or results in outright application denial depending on the carrier. Most insurers require you to be tobacco-free for 2-5 years before offering standard rates. A history of drug or alcohol abuse requires documented sobriety for 5-10 years before most carriers will consider coverage, along with proof of treatment completion and ongoing recovery support participation.

• Tobacco impact: 25-50% premium increase or denial for current smokers
• Tobacco-free requirement: 2-5 years smoke-free for standard rates
• Substance abuse history: 5-10 years documented sobriety plus treatment proof required

Severe obesity with BMI over 40 typically disqualifies applicants due to associated health risks including diabetes, heart disease, joint problems, and sleep apnea. Moderate overweight status with BMI between 30-40 usually qualifies but may result in premium increases of 10-20% above standard rates.

• Severe obesity (BMI 40+): Typically disqualifies due to health risks
• Moderate overweight (BMI 30-40): Qualifies with 10-20% premium increase
• Associated risks: Diabetes, heart disease, joint problems, sleep apnea

10. Hybrid vs Traditional Long-Term Care Insurance

Traditional long-term care policies offer the lowest annual premiums—typically $2,000-3,500 for comprehensive coverage—but provide zero benefit if you never need care. You’ve essentially paid premiums for decades with nothing to show for it, which many families find frustrating.

• Traditional premiums: $2,000-3,500/year for comprehensive coverage
• Use it or lose it: No benefit if you never need long-term care
• Frustration factor: Decades of premiums with no return if care isn’t needed

Hybrid policies combine life insurance with long-term care benefits, guaranteeing a return regardless of whether you need care. If you require long-term care, the policy pays benefits just like traditional coverage. If you die without ever needing care, your beneficiaries receive a life insurance death benefit. Premiums are higher—expect $4,000-8,000 annually—but you’re guaranteed your money provides value either way. For Houston families with $2 million or more in assets, hybrid policies eliminate the “use it or lose it” concern while providing both wealth protection and legacy planning benefits.

• Hybrid premiums: $4,000-8,000/year but guarantees return
• Dual benefits: LTC coverage if needed OR death benefit if not
• Best for: Houston families with $2M+ assets seeking guaranteed value

11. Application Documentation Errors That Cause Denial

Incomplete medical records, undisclosed medications, or inaccurate health history statements frequently trigger application denials. Insurance companies cross-reference your application against pharmacy databases—if you fail to list prescriptions or doctor visits, your application gets flagged for misrepresentation and denied.

• Common errors: Incomplete records, undisclosed medications, inaccurate history
• Cross-referencing: Insurers check pharmacy databases for prescription verification
• Misrepresentation consequences: Flagged application leads to automatic denial

Be exhaustively thorough when completing applications. List every doctor you’ve seen in the past 10 years, every medication you currently take or have taken, every surgery or hospitalization, and every diagnosis regardless of how minor it seems. An omission you consider insignificant might be exactly the information that disqualifies you, and discovered omissions after policy issuance can result in coverage rescission precisely when you need it most.

• Thorough disclosure: 10 years of doctors, medications, surgeries, diagnoses
• Minor details matter: Seemingly insignificant omissions can disqualify
• Rescission risk: Discovered omissions after issuance can cancel coverage when needed

12. How to Get Long-Term Care Insurance After Being Denied

One insurer’s denial doesn’t mean universal disqualification. Underwriting standards vary significantly between carriers—what disqualifies you at Company A might be acceptable at Company B with higher premiums or benefit limitations. Work with an independent insurance broker who can shop your application to multiple carriers simultaneously to maximize approval chances.

• Underwriting varies: Standards differ significantly between insurance carriers
• Shop multiple carriers: Independent brokers access multiple companies simultaneously
• Higher premiums possible: Some carriers accept with rate increases or benefit limits

If traditional coverage remains unavailable, consider alternatives. Asset-based long-term care using life insurance cash value typically has more lenient medical underwriting. Annuities with long-term care riders require minimal health questions and may accept applicants traditional policies decline. For Houston business owners and high-net-worth individuals with $5 million or more in assets, self-insurance strategies combined with Medicaid planning using asset protection trusts may prove more cost-effective than purchasing traditional insurance.

• Asset-based alternatives: Life insurance cash value with more lenient underwriting
• Annuity riders: Minimal health questions, accepts more applicants
• Self-insurance: For $5M+ net worth, may be more cost-effective than traditional policies

13. Texas Medicaid Asset Limits for Long-Term Care

Without long-term care insurance, Texas Medicaid requires asset spend-down to $2,000 for individuals or $148,620 for married couples before providing nursing home coverage. Your primary residence, one vehicle, and certain personal property receive exemption, but investment accounts, rental properties, vacation homes, and business interests must be liquidated to qualify.

• Individual limit: $2,000 in countable assets to qualify for Medicaid
• Married couple limit: $148,620 in countable assets
• Must liquidate: Investment accounts, rental properties, vacation homes, business interests

Texas enforces a 5-year look-back period, penalizing asset transfers made to artificially qualify for Medicaid. If you transferred $250,000 to your children three years before applying for Medicaid, you’ll face a penalty period during which Medicaid won’t pay for your care despite your depleted assets. Long-term care insurance purchased in your 50s prevents this forced wealth depletion, protecting assets you’ve spent decades building for your family’s benefit rather than nursing home bills.

• 5-year look-back: Asset transfers within 5 years trigger Medicaid penalties
• Penalty period: Medicaid won’t pay during penalty period despite depleted assets
• Insurance prevents depletion: Coverage purchased in 50s protects family wealth

What Hotaling Insurance Services Provides

Hotaling Insurance Services specializes in long-term care planning for Houston’s affluent families, business owners, and professionals. Our team evaluates your current health profile, family medical history, financial situation, and wealth preservation goals to recommend optimal coverage solutions—whether traditional policies, hybrid life insurance with long-term care benefits, annuities with LTC riders, or sophisticated self-insurance strategies for high-net-worth clients.

• Specialized planning: Houston affluent families, business owners, professionals
• Comprehensive evaluation: Health profile, family history, financial situation, wealth goals
• Multiple solutions: Traditional, hybrid, annuities, self-insurance strategies

We maintain relationships with multiple A-rated insurance carriers, allowing us to shop your application to companies most likely to approve your specific health profile at competitive rates. Contact our Houston office to schedule a comprehensive long-term care planning consultation and protect your family’s wealth from catastrophic care costs.

• Multiple carriers: Relationships with A-rated insurance companies
• Application shopping: Find carriers most likely to approve your health profile
• Houston consultation: Schedule comprehensive long-term care planning session

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Disclaimer: This article is for informational purposes only and does not constitute insurance, financial, or legal advice. Long-term care insurance eligibility varies by carrier and individual circumstances. Consult with qualified professionals to evaluate your specific situation.