Pre-existing conditions and medical history are the main reasons insurers deny coverage
Long-term care insurance underwriters reject applications most often because of medical conditions that existed before you applied. Insurers use medical records, doctor visits, and prescription history to assess your risk of needing care in the next few years. If you have a diagnosis that typically leads to long-term care — Alzheimer's disease, Parkinson's disease, multiple sclerosis, or advanced arthritis — you will not be offered a policy at any price.
Conditions that don't automatically disqualify you but make approval harder include diabetes, heart disease, cancer history, and cognitive decline. The insurer's underwriting guidelines determine where the line falls, and those guidelines vary by company. Some insurers are stricter than others; if one denies you, another might not. The timing of your diagnosis matters too — if you were diagnosed five years ago and have been stable since, you have a better chance than if you were diagnosed last year.
Functional limitations also trigger denials. If you already need help with activities of daily living — bathing, dressing, toileting, transferring, continence, or eating — you are already in the state the insurance is meant to cover. Insurers will not insure someone who is already disabled. Similarly, if you have had a recent fall, stroke, or hospitalization, underwriters may postpone your application or deny it outright.
Key Takeaways
- Serious diagnoses like Alzheimer's, Parkinson's, and multiple sclerosis result in automatic denial from all insurers.
- Chronic conditions such as diabetes and heart disease make approval harder but do not automatically disqualify you; different insurers have different thresholds.
- If you already need help with daily activities like bathing or dressing, you cannot buy long-term care insurance because you are already in the state it covers.
- Recent hospitalizations, falls, or cognitive decline can trigger denial or a delay in underwriting while the insurer waits to see if your condition stabilizes.
- Age alone does not disqualify you, but the older you are when you apply, the more scrutiny your medical history receives.
Cognitive and mental health conditions that stop approval
Dementia, Alzheimer's disease, and any diagnosis of cognitive impairment will result in denial. Insurers consider these conditions a near-certain path to long-term care, so they do not take the risk. The same applies to Parkinson's disease and other progressive neurological conditions. If you have been diagnosed with mild cognitive impairment or have had memory problems documented in your medical records, underwriters will likely deny your application or request extensive neuropsychological testing before deciding.
Mental health diagnoses create a separate barrier. A history of bipolar disorder, schizophrenia, or severe depression can result in denial, particularly if you have been hospitalized or have had recent episodes. Insurers view these conditions as unpredictable and potentially disabling. If you have been treated for depression or anxiety but have been stable for several years with no hospitalizations, some insurers may approve you, but others will not. Alcohol or substance use disorder — whether current or in your history — is grounds for denial at most carriers.
Functional limitations and current care needs
If you cannot perform at least five of the six activities of daily living without help, you are already functionally impaired and will be denied. These activities are bathing, dressing, toileting, transferring from bed to chair, continence control, and eating. An insurer's job is to cover the cost of care when you lose these abilities; they will not insure someone who has already lost them.
Recent falls, fractures, or hospitalizations also raise red flags. If you fell and broke a hip in the past year, or if you were hospitalized for pneumonia or surgery within the last six months, underwriters may delay your application while they assess whether you will recover fully. Some insurers have specific waiting periods — they will not consider your application until a certain amount of time has passed since your event. Others may approve you but exclude coverage related to that condition.
Age and timing of your application
Age itself does not disqualify you, but it affects how closely insurers examine your health. Someone applying at 50 with no medical history faces minimal underwriting. Someone applying at 80 with the same health history faces much more scrutiny because the statistical likelihood of needing care is higher. Insurers may require additional testing — blood work, cognitive screening, or a medical exam — if you are over 75 or 80, depending on the company.
The timing of your application relative to a diagnosis matters significantly. If you were diagnosed with a condition last month, you will almost certainly be denied. If you were diagnosed five years ago, have been stable, and your doctor confirms you have no functional limitations, you have a reasonable chance. Insurers often use a rule of thumb: the more recent the diagnosis or event, the more likely the denial. Waiting a year or two after a health scare can improve your odds, though it also means paying premiums for longer before coverage begins.
Lifestyle and medication use that triggers denial
Current or recent alcohol or drug use is grounds for automatic denial. If you are in active treatment for substance use disorder, or if your medical records show recent use, insurers will not cover you. A history of use that is now resolved may be approved by some carriers, but you will need documentation of treatment completion and sustained sobriety.
Certain medications can also signal risk that insurers want to avoid. If you are taking medications for dementia, Parkinson's disease, or other progressive neurological conditions, you will be denied. If you are on multiple psychiatric medications or have had recent changes to your psychiatric medication regimen, underwriters may deny you or request additional information from your doctor. Medications for cancer treatment or recent cancer diagnosis are also common reasons for denial.
Driving record and living situation concerns
Some insurers ask about your driving record and whether you have had recent accidents or traffic violations. Multiple accidents or violations in the past few years can raise questions about your judgment and safety, though this is less common as a disqualifying factor than medical history. A few insurers also consider whether you live alone or have family support, though this is not a formal disqualifier — it is more of a risk assessment tool.
If you are already receiving Medicaid or have already been approved for disability benefits, some insurers view this as evidence that you are already in poor health and may deny you. Others do not consider it a barrier. This varies by company and by state.
What happens if you are denied
If one insurer denies you, you can apply to another. Underwriting standards vary, and a company that denies you may have different risk tolerance than a competitor. Keep in mind that each application generates a record in the Medical Information Bureau (MIB), a database that insurers use. Multiple denials in a short time can make future applications harder because insurers see the pattern of rejections.
If you are denied because of a recent health event, you can reapply after waiting a period of time — typically six months to a year — to show that you have recovered or stabilized. Some insurers will reconsider if your doctor provides a letter stating that your condition has improved or that you have regained function. Others will not reconsider at all. Before reapplying, ask the insurer what would need to change for them to approve you.
If you cannot obtain traditional long-term care insurance, you may be able to buy a hybrid policy that combines life insurance or annuities with long-term care riders. These policies have less stringent underwriting and may be available even if traditional long-term care insurance is not. They cost more and provide less coverage, but they are an option if you have been denied elsewhere.
Frequently Asked Questions
Will I be denied if I take blood pressure medication?
No. High blood pressure that is controlled by medication is not a disqualifying condition. Insurers are concerned about uncontrolled conditions or conditions that have caused complications like stroke or heart attack. If your blood pressure is stable and you have no history of heart disease or stroke, you should be approved.
Can I be denied because I am overweight or obese?
Weight alone is not a disqualifying factor, but obesity combined with other conditions — diabetes, heart disease, or joint problems — can make approval harder. If you are obese but have no other medical conditions and your doctor confirms you have no functional limitations, most insurers will approve you, though some may charge higher premiums.
What if I have had cancer but I am in remission?
Cancer in remission does not automatically disqualify you, but the timing and type matter. If you were diagnosed and treated five years ago and have had no recurrence, you have a good chance of approval. If you were diagnosed two years ago, underwriters may deny you or require additional documentation from your oncologist. Some insurers have specific waiting periods — they will not consider applications from cancer survivors until a certain number of years have passed since treatment ended.
Can I be denied because of my age alone?
No. Age is not a legal reason to deny coverage. However, insurers can require more extensive medical underwriting as you get older, and they can charge higher premiums. If you are 85 and in good health, you can still buy long-term care insurance, but you will pay more and may need to pass additional medical tests.
If I am denied, can I appeal the decision?
Yes. You have the right to request that the insurer reconsider their decision. Provide additional medical records or a letter from your doctor explaining your current health status. If the insurer denies your appeal, you can file a complaint with your state's insurance commissioner. You can also apply to a different insurer, as underwriting standards vary by company.