Life insurance companies test your health to set your rate and decide whether to cover you

When you apply for life insurance, the company uses medical tests to understand your health risk. The tests vary by the amount of coverage you're seeking and your age. A $250,000 policy might require only your medical history and a phone call. A $1 million policy usually means blood work, urine tests, and possibly an EKG or chest X-ray. The company is trying to predict whether you're likely to die during the policy term — and at what cost to them.

The tests themselves are straightforward and happen at your home or a local lab, at no cost to you. You don't pay for underwriting. What matters more is what the results mean: a high cholesterol reading, a history of heart disease, or diabetes can raise your rate significantly or result in a decline. Some conditions don't disqualify you but do change the price you'll pay.

Key Takeaways

  • Medical exams are free to you and typically include blood work, urine tests, and sometimes an EKG, depending on the coverage amount and your age.
  • Life insurance companies test for cholesterol, blood pressure, blood sugar, liver and kidney function, nicotine use, and HIV — not recreational drugs.
  • The underwriting process usually takes two to four weeks, and you can't speed it up by paying more or choosing a different company.
  • Lying on your application can result in the company denying a claim years later, even if you've paid premiums the whole time.
  • Some conditions raise your rate but don't prevent you from getting coverage; others may result in a decline or a waiting period.

What blood work and urine tests reveal

Blood tests check your cholesterol levels (total, HDL, and LDL), blood sugar, liver enzymes, kidney function, and whether you have HIV or hepatitis. The company is looking for signs of heart disease, diabetes, liver disease, and infectious disease — the conditions most likely to shorten your life. A single high reading doesn't automatically raise your rate; the company looks at the pattern and whether you're being treated.

Urine tests screen for protein, glucose, and blood — signs of kidney disease or diabetes — and also detect nicotine metabolites. This is how the company knows if you smoke, even if you say you don't. Nicotine stays in your urine for three to four days, so the test is reliable. If you use nicotine products and claim you don't, the company will either decline you or charge you the smoker rate, which is typically 50 to 100 percent higher than the non-smoker rate.

Blood pressure, EKG, and other cardiac screening

Your blood pressure is taken during the exam. A single high reading won't disqualify you, but consistently elevated blood pressure — especially if untreated — raises your rate. If you have a history of heart attack or stroke, or if you're over 60 and seeking a large benefit amount, the company may order an EKG (electrocardiogram) to check your heart rhythm and look for signs of past heart damage.

A chest X-ray is less common but may be ordered if you're a smoker, have a history of lung disease, or are applying for a very large benefit. The company wants to rule out lung cancer or other serious conditions before issuing the policy. These tests are done at a local imaging center or lab, still at no cost to you.

What the company does not test for

Life insurance companies do not test for recreational drugs like marijuana or cocaine. They test for nicotine because it's a legal product that affects your health; they don't care whether you use other substances. However, if you disclose drug use on your application or if it shows up in your medical records, the company may decline you or charge a higher rate based on the health risks associated with that use.

The company also doesn't test for mental health conditions directly, but they do ask about them on the application. If you've been hospitalized for depression, attempted suicide, or have a diagnosis of bipolar disorder or schizophrenia, you must disclose it. Some companies decline applicants with recent suicide attempts; others charge a higher rate or require a waiting period. Lying about mental health history is a common reason claims get denied years later.

How your medical history affects the underwriting decision

The company pulls your medical records from your doctors and reviews your history of treatment. If you have diabetes, they want to know your A1C level and whether you're taking medication. If you have high blood pressure, they want to see that you're on medication and that your readings are controlled. Untreated conditions raise your rate more than treated ones.

Cancer, heart disease, and stroke are the conditions most likely to result in a decline or a very high rate. But the company also considers how long ago the event was and whether you've recovered. Someone who had a heart attack five years ago and has been healthy since may get approved at a standard or slightly elevated rate. Someone who had one last year will likely be declined or offered coverage at a much higher cost.

The timeline and what happens if you're declined

Underwriting typically takes two to four weeks. The company orders your tests, receives the results, pulls your medical records, and makes a decision. You can't speed this up by paying a fee or switching companies — every company follows the same underwriting process. During this time, you have no coverage, so if something happens to you, the policy doesn't pay.

If you're declined, the company must tell you why. You have the right to see the medical information they used and to dispute it if it's wrong. If your doctor's records contain an error, you can ask your doctor to send a correction to the insurance company. You can also reapply after your health improves — for example, after you've controlled your blood pressure for six months or after you've quit smoking for a year.

Why honesty on your application matters

The application asks detailed questions about your health history, medications, surgeries, and lifestyle. You must answer truthfully. If you lie and the company finds out — either during underwriting or years later when someone files a claim — they can deny the claim and keep the premiums you've paid. This is called contestability, and it typically lasts two years from the date the policy starts.

After two years, the company generally can't deny a claim based on misstatements in the application, even if they were intentional. But during those first two years, if your beneficiary tries to claim and the company discovers you lied about your health, they can refuse to pay. It's not worth the risk. If you're unsure whether something counts as a medical condition you should disclose, ask your agent or the company directly before you submit the application.

Frequently Asked Questions

Do I have to take the medical exam, or can I get life insurance without one?

You can get coverage without a medical exam through may provide issue or simplified issue policies, but they cost more and have lower benefit limits — usually $10,000 to $50,000. If you want a larger benefit at a lower rate, you'll need to go through underwriting and take the exam. Most people in good health come out ahead by doing the exam.

What if I have a pre-existing condition like diabetes or high blood pressure?

You can still get life insurance, but your rate will be higher than someone without that condition. The company wants to see that you're being treated and that your condition is controlled. Bring records showing your medication and recent test results to the exam. Being treated and stable is better than being untreated in the company's eyes.

Will the life insurance company share my medical information with my employer or anyone else?

No. The information stays between you and the insurance company. Your employer doesn't see your medical records, even if they're paying for the policy. The only exception is if you authorize the company to share information with someone specific, like your financial advisor.

How long do test results stay on file, and can I reapply if I was declined?

Test results are typically valid for 60 days. If you're declined, you can reapply after your health improves. There's no waiting period required by law, but it makes sense to wait until you've addressed the reason you were declined — for example, getting your blood pressure under control or quitting smoking for several months.

Can I switch life insurance companies if I don't like my rate after underwriting?

Yes, but you'll go through underwriting again with the new company, and they may come to the same conclusion about your health and rate. Shop around before you apply, not after. Once you're approved at a certain rate, you can lock it in by accepting the policy. If you decline and apply elsewhere, you're starting over.