Long-term care insurance underwriting hinges on your health status, and most carriers require a medical exam before approving coverage. Understanding what to expect—and how your results affect eligibility and premiums—helps you prepare strategically and avoid surprises. This guide walks you through the underwriting process so you can move forward confidently.
Why Insurers Order Medical Exams
Long-term care insurance covers expenses for nursing homes, assisted living, and in-home care—bills that can easily exceed $100,000 per year. Insurers conduct medical exams to assess your health risk and predict the likelihood you'll need benefits sooner rather than later. The healthier you are at underwriting, the lower your premiums and the better your chance of approval.
Most carriers require an exam if you're applying for significant coverage amounts (typically $150,000+ in benefits) or if you're over age 60. Younger applicants under 50 might skip the exam entirely if they're in good health and requesting modest benefits.
What's Included in a Standard Medical Exam
The typical exam is non-invasive and takes 30–45 minutes. A paramedic or nurse visits your home or office, and you won't need to fast or reschedule your day.
Common components include:
- Blood pressure, heart rate, and basic vital signs
- Height and weight measurements
- Blood and urine samples (sent to a lab for routine screening)
- Medical and prescription medication history review
- Cognitive assessment questions (memory, reasoning, orientation)
- Functional capacity questions (can you bathe, dress, manage finances independently?)
- Lifestyle questions (alcohol use, smoking status, driving record)
Results typically come back within 2–3 weeks. Blood work screens for diabetes, heart disease, liver and kidney function, and cholesterol levels.
How Health Conditions Affect Underwriting Approval
Insurers use detailed underwriting guidelines, but some conditions automatically disqualify applicants or trigger rate increases. Here's what commonly matters:
Automatic denial or significant postponement risk:
- Alzheimer's disease or advanced dementia
- Recent cancer diagnosis (typically within 2–5 years)
- Advanced Parkinson's disease or ALS
- Severe cognitive impairment already diagnosed
Conditions that increase premiums (sometimes substantially):
- Diabetes (especially if poorly controlled)
- Heart disease or history of stroke
- High blood pressure not well-managed
- Obesity (BMI over 35–40 depending on carrier)
- Depression or anxiety on active medication
Conditions that typically don't block approval:
- Well-controlled high blood pressure
- Previous surgeries with good recovery
- Seasonal allergies or minor arthritis
- Mild cognitive impairment (early-stage only)
Approval timelines range from 2–4 weeks for clean underwriting to 2–3 months if the carrier requests additional medical records or specialist reports.
Timing Matters: When to Apply
Your age and health trajectory directly impact cost. A 55-year-old in good health might pay $1,500–$2,500 annually for $250,000 in benefits; that same person at 65 could pay $3,000–$5,000 or face tighter underwriting. Applying earlier gives you a wider approval window and lower lifetime premiums, even if you don't need benefits for decades.
If you're managing a recent diagnosis (high blood pressure, diabetes), wait 6–12 months after successful treatment to show stable control. This improves your chances and reduces rate increases.
Questions to Ask Your Insurer Before the Exam
Clarify expectations upfront:
- Will the exam cost extra, or is it covered as part of the underwriting process? (Almost always covered by the insurer.)
- What happens if your bloodwork flags something? Do you automatically get denied, or does the carrier review context?
- Can you request the exam results? (Most carriers will share them with you.)
- If you're declined, can you reapply after addressing a specific health issue?
Working With a Long-Term Care Insurance Advisor
A broker or advisor with underwriting experience can guide you on realistic approval odds before you invest time in the exam. They can also help you compare carriers, since underwriting standards vary—one insurer might decline you for mild diabetes while another approves you at standard rates. Platforms like Mercoly help you compare and find trusted long-term care insurance providers in one place, so you can see multiple underwriting standards side by side.
Frequently Asked Questions
Q: Will I automatically be denied if I have high blood pressure or diabetes? No. Well-controlled conditions typically result in standard or slightly elevated rates. Uncontrolled or newly diagnosed conditions may trigger additional underwriting review or postponement until you've demonstrated stable treatment for 6+ months.
Q: Can I retake the medical exam if results come back unfavorable? Most carriers won't allow immediate retesting, but you can reapply after 6–12 months if you've addressed the flagged health issue. Some carriers allow one reconsideration request if new information becomes available.
Q: How much does the medical exam cost? The insurer covers all exam costs. There's no out-of-pocket charge to you.
Use these insights to prepare for your exam and make an informed decision about when to apply.