Qualifying for Long-Term Care Coverage

Last updated: October 7, 2015

Do You Know if You Qualify?

Underwriting

Companies selling long-term care insurance “underwrite” their coverage. This means the company looks at your health and health history before it issues you a policy. If you do not meet the guidelines established by the company, you may not qualify for coverage. 

  • The Kansas Insurance Department cannot force a long term care insurance company to accept you and issue you a policy.

Some companies do what is known as “short-form” underwriting. On the application for coverage, they will ask you to answer just a few questions about your health. 

  • For example, they may want to know if you have been hospitalized in the past 12 months or have been confined to a wheelchair. Some companies may ask for more information, examine your current medical records, or ask for a health statement from your doctor.

No matter what kind of underwriting a company uses, it is important to answer all health questions as truthfully as possible

  • If a company later learns you did not fully disclose your health status on the application, it could refuse to pay your claim or could cancel your policy.

A copy of your application generally will be attached to your policy. Review this application: 

  • Be certain that you have answered all health questions and that the information you provided to the company is complete.

Pre-Existing Conditions

Companies may impose a waiting period for "pre-existing conditions". This means that policy benefits will not be paid for services related to conditions which existed before you purchased the policy. 

  • If the company discovers you have not disclosed a pre-existing condition on your application, it may refuse to pay for treatment related to that condition and could terminate your coverage.

Factors Affecting Your Premium

Generally, your premium is based on the following:

Age — The younger you are when you buy a policy, the less you pay in premiums.

Elimination period — Premiums are less if you increase the elimination period. The longer you can wait for benefits to begin, the lower your premium will be. 

Benefits — A policy paying $50 a day for three years will cost less than one paying $100 a day for five years. To decide the benefit amount you would like to have, multiply an estimated daily cost of care and by the number of days of care for which you want coverage.

(Dollar amount per day) X (Number of days) = (Policy coverage or benefit amount)

Other factors — Where you live, your health at the time the policy is issued, and any optional benefits you decide to add to your policy may increase your costs.

Premiums on long-term care policies will probably increase in the future.

Insurance companies may raise the premiums on their policies but only if they increase the premiums on all policies. No individual can be singled out for a rate increase, regardless of the number of claims they’ve filed. 

  • When companies increase their premiums, it does not mean they will increase policy benefits.

What Is Not Covered 

Kansas laws allow policies to have these exclusions:

  • Pre-existing condition — A pre-existing condition is an illness or disability for which you received medical advice or treatment during a specified period before applying for insurance. Most long-term care policies will not pay benefits for these conditions for a certain length of time, usually 6 months, after you become insured.
  • Care by family members — Most policies will not pay members of your family to take care of you. Some policies will pay to train family members to be your care provider. Check with the insurance company.
  • Mental and emotional disorders or disease, other than Alzheimer’s disease.
  • Alcoholism and drug addiction.
  • Illness or accident caused by an act of war or a felony.
  • Treatment already paid for by Medicare or any government program except Medicaid.
  • Attempted suicide or intentionally self-inflicted injuries. 

This article is published on KansasMoney.gov. Find more information by contacting these state agencies: