Process Overview
Applying for long-term care insurance involves more scrutiny than other types of insurance. Unlike auto or homeowners insurance, LTC insurance involves medical underwriting—a thorough evaluation of your health to determine eligibility and pricing.
Understanding the process helps you prepare properly, set realistic expectations, and maximize your chances of approval at favorable rates.
The Journey at a Glance
Application
1–2 hours
Underwriting
3–6 weeks
Decision
1–2 weeks
Policy Delivery
1 week
Total timeline: typically 4–8 weeks from application to policy in hand
Step 1: The Application
The application gathers the information underwriters need to evaluate your risk. It typically takes 45 minutes to an hour to complete, though complex medical histories may take longer.
What You'll Be Asked
Personal Information
Name, date of birth, address, Social Security number, occupation, marital status, and beneficiary designations.
Medical History
Current conditions, past diagnoses, surgeries, hospitalizations, medications, and treatments. You'll be asked about specific conditions (heart disease, diabetes, cancer, neurological conditions, etc.).
Physician Information
Names and contact information for your doctors. The carrier will request your medical records from these providers (with your authorization).
Family History
Health history of parents and siblings, particularly cognitive conditions like Alzheimer's or dementia.
Lifestyle Questions
Tobacco use, alcohol consumption, driving record, dangerous hobbies, and international travel to certain regions.
Before You Apply
- • Gather your prescription medication list (names, dosages)
- • Have your doctors' names and contact information handy
- • Know your height, weight, and general health metrics
- • Be prepared to discuss your complete medical history honestly
Step 2: Medical Underwriting
After you submit the application, the underwriting process begins. This is where the insurance company verifies your health information and assesses your risk.
What Happens During Underwriting
Paramedical Exam
20–40 minA certified examiner comes to your home or office to conduct basic health measurements.
- •Height, weight, blood pressure, pulse
- •Blood draw for lab work (cholesterol, glucose, liver/kidney function, HIV)
- •Urine sample
- •Sometimes an EKG for older applicants
Phone Interview
15–30 minA nurse or health professional calls to review your medical history in detail.
- •Verification of application answers
- •Detailed questions about specific conditions
- •Cognitive screening questions (especially for applicants 65+)
- •Questions about daily activities and functional abilities
Medical Records Request
2–4 weeksThe carrier requests your medical records from doctors you listed.
- •Attending Physician Statements (APS) from your doctors
- •Hospital records if you've had recent hospitalizations
- •Specialist records for specific conditions
- •This is often the longest part of the process
Underwriter Review
1–2 weeksAn underwriter reviews all gathered information and makes a decision.
- •Compares your health profile to underwriting guidelines
- •May request additional information if questions arise
- •Assigns a risk classification
The Cognitive Assessment
Step 3: The Decision
After underwriting is complete, you'll receive one of several possible outcomes:
Approved at Standard Rates
You qualify for coverage at the standard premium rate for your age. This is the best outcome—you're in the carrier's preferred risk pool.
Approved at Preferred Rates
You're in excellent health and qualify for a discount off standard rates. Not all carriers offer preferred classes, but those that do reward exceptional health.
Approved with Rating (Substandard)
You qualify for coverage, but with a higher premium due to health conditions. Ratings typically add 25%–100% to the standard premium. You can accept the rated policy or decline.
Approved with Exclusions
You qualify, but certain conditions are excluded from coverage. For example, coverage might exclude claims related to a pre-existing back condition. Less common with LTC than with other insurance types.
Declined (Not Approved)
You don't qualify for coverage with this carrier. This could be due to existing health conditions, cognitive concerns, or other risk factors. A decline from one carrier doesn't necessarily mean all carriers will decline.
Postponed
The carrier wants to wait before making a decision—perhaps until a recent health event stabilizes or a treatment course is completed. You may be able to reapply after a waiting period.
Step 4: Policy Delivery
Once you're approved and accept the offer, the carrier issues your policy. Here's what happens:
Premium Payment
You pay the first premium (or, for asset-based products, the single premium deposit). Coverage typically begins on the date the premium is received.
Policy Documents
You receive the policy contract, typically by mail. Review it carefully to ensure it matches what you applied for.
Free Look Period
You have a "free look" period (usually 30 days) to review the policy. If you change your mind, you can return it for a full refund of premiums paid.
Store Safely
Keep the policy in a safe place and let family members know where it is. A policy that can't be found when needed doesn't help anyone.
What Underwriters Look For
Understanding what matters to underwriters helps you assess your own situation and set realistic expectations:
Cognitive Health
Any signs of cognitive decline, memory issues, or dementia diagnoses are heavily weighted. Even mild cognitive impairment often results in decline.
Cardiovascular Health
Heart disease, stroke history, and uncontrolled high blood pressure are significant concerns. Well-controlled conditions fare better.
Neurological Conditions
Parkinson's, MS, ALS, and similar conditions typically result in decline or significant rating due to high likelihood of needing care.
Diabetes
Well-controlled Type 2 diabetes is often insurable with rating. Poorly controlled diabetes or Type 1 is more challenging.
Mobility Issues
Difficulty with walking, balance problems, or history of falls raises concerns about functional independence.
Recent Cancer
Active cancer typically results in postponement. History of cancer varies by type, stage, and time since treatment.
Weight/BMI
Significantly overweight or underweight applicants may face rating or decline, but moderate weight issues are usually manageable.
Tobacco Use
Smokers typically pay higher premiums but can still qualify. Some carriers are more tobacco-friendly than others.
Automatic Declines
Improving Your Odds of Approval
While you can't change your medical history, you can position yourself for the best possible outcome:
Get Your Health in Order First
If you have conditions that could be better controlled (blood pressure, cholesterol, diabetes), work with your doctor to optimize them before applying.
Apply Before Health Changes
The longer you wait, the more likely health issues develop. Today is almost always better than tomorrow for underwriting purposes.
Work with a Specialist
An experienced LTC insurance specialist knows which carriers are most favorable for your specific health profile and can guide your application appropriately.
Be Thorough and Honest
Complete disclosure is essential. Omissions can lead to claim denials later. If something is in your medical records, assume underwriters will see it.
Know Your Medications
Bring a complete list of medications with dosages. Some medications are red flags for certain conditions even if you haven't mentioned the condition.
Prepare for the Phone Interview
Be rested and alert for the cognitive screening. Answer questions naturally—trying to anticipate 'right' answers can backfire.
If You're Declined
A decline from one carrier doesn't mean you're uninsurable. Here are your options:
Try Another Carrier
Underwriting guidelines vary significantly between companies. A condition that results in decline at one carrier may be accepted (perhaps with rating) at another. Your specialist can help identify which carriers might be more favorable.
Consider Simplified Underwriting Products
Some annuity-based LTC products have simplified underwriting that accepts conditions traditional products don't. Benefits may be more limited, but something is often better than nothing.
Look at Life Insurance with Chronic Illness Riders
These products often have easier underwriting than standalone LTC insurance. The LTC-like benefits are more limited, but they can provide partial protection.
Request the Specific Reason
You have the right to know why you were declined. This information can help you and your specialist determine whether another carrier might view your situation differently.
Revisit Later
If you were declined due to a recent health event, you may be able to reapply after a period of stability. Ask when it would be appropriate to try again.
Knowledge Is Power
Understanding the application process helps you approach it with confidence rather than anxiety. Prepare thoroughly, be honest, and work with an experienced specialist who can guide you to the carriers most likely to view your application favorably. The effort you put in upfront pays off in better outcomes.
Frequently Asked Questions
About the Author
Brian Thompson
LTC Insurance Specialist
Brian has spent over 30 years helping families navigate long-term care planning. As an independent broker licensed in 48 states, he specializes in asset-based LTC strategies that keep your money working for you—no matter what happens.