Who qualifies for long term care insurance? In most cases, people who are still living independently, managing their health reasonably well, and able to perform everyday tasks without assistance can qualify. Long term care underwriting is different from life insurance underwriting because the carrier is not just looking at mortality risk. They are evaluating the probability that you will need help with daily living activities or supervision due to cognitive decline in the years ahead.

At Diversified Insurance Brokers, we help clients nationwide understand what long term care insurers are actually looking for, which medical and lifestyle factors matter most, and how to position an application so you can maximize approval odds and avoid unnecessary declines. The goal is not only to get approved—it’s to get approved into a plan design that fits your budget and gives you meaningful protection.

How long term care underwriting works

Long term care insurance is designed to help pay for care when you can’t safely manage certain daily living activities on your own, or when cognitive impairment creates a supervision need. Because of that, underwriting focuses heavily on independence. A carrier wants to see that you are currently functioning well, that your medical conditions are stable, and that there are no strong indicators of near-term need for care.

Most underwriting decisions are based on a combination of your age, health history, medications, build (height/weight), recent doctor visits, and mobility or balance indicators. Carriers also look for signs that you already need help at home, rely on a walker or wheelchair, have frequent falls, or have diagnosed cognitive impairment. Even when a person feels “fine,” underwriting still evaluates the risk of functional decline rather than just the diagnosis list.

In most cases, the process includes a health questionnaire, prescription database review, medical record checks as needed, and sometimes an interview or cognitive screen. The exact steps vary by carrier and by policy type, but the evaluation always comes back to the same core question: are you currently independent and likely to remain independent long enough for the plan to make actuarial sense?

Basic eligibility requirements most carriers look for

Age matters, but it isn’t the whole story. Many applicants shop for long term care between ages 50 and 70, and some carriers will consider applicants into the mid-70s depending on health and plan type. The bigger issue is not whether you are “too old,” but whether you are still healthy enough to qualify for a plan you can keep. Applying earlier often expands carrier options and improves pricing, but older applicants can still qualify when overall health and daily function are strong.

Current independence is the foundation of approval. Long term care insurers generally want applicants who can perform basic activities of daily living—bathing, dressing, eating, toileting, transferring, and continence—without hands-on help. If you already need assistance with these tasks, underwriting becomes much more difficult because that signals the claim risk may be near-term.

Mobility and balance are major decision points. Carriers pay close attention to fall history, gait stability, and the use of assistive devices. A person can have several manageable medical conditions and still qualify, but repeated falls or a progressive mobility issue can lead to a decline because it directly correlates with future care needs.

Medical stability matters more than a perfect history. Many people assume any diagnosis means decline. In reality, insurers often approve applicants with common conditions when those conditions are well-managed, consistent, and not creating functional limitations. The underwriting challenge typically comes from uncontrolled conditions, frequent complications, multiple recent hospitalizations, or conditions strongly associated with cognitive decline or loss of independence.

Common medical issues—and how they typically impact LTC eligibility

Every carrier has its own underwriting guide, but there are predictable patterns in how long term care underwriters view different medical histories. Instead of thinking in terms of “approved” or “declined,” it helps to think in terms of what the condition says about future independence.

High blood pressure and cholesterol are frequently viewed as manageable risks when well-controlled and supported by consistent follow-up care. Underwriters usually focus on complications. If blood pressure is controlled and there is no history of stroke, heart failure, or significant vascular disease, many applicants still qualify.

Type 2 diabetes is often acceptable when controlled, especially when A1C has been stable, there are no significant complications, and the person remains active and independent. Risk increases when diabetes is poorly controlled, has led to neuropathy that affects balance, has caused kidney concerns, or is paired with significant cardiovascular disease.

Build and weight can influence outcomes, mainly because severe obesity can increase the probability of mobility impairment, sleep apnea complications, joint deterioration, and other issues that raise care risk. The key point is not the number alone—it’s whether weight is contributing to functional limitations, shortness of breath with minimal exertion, or increased fall risk.

Cancer history is often evaluated by recency, severity, and ongoing treatment needs. Many applicants qualify after being in remission for a meaningful period and having stable follow-up, especially when there is no ongoing aggressive therapy and daily function is intact. Underwriters may be cautious with recent cancers, metastatic history, or treatment side effects that impact mobility or cognition.

Cognitive impairment or dementia diagnoses are among the most difficult categories for traditional long term care underwriting. The reason is direct: cognitive decline is closely tied to long duration care needs, supervision requirements, and higher probability of claim. Even early indicators can trigger additional screening and medical review.

Stroke and severe neurological concerns are often evaluated based on residual deficits. If there is meaningful impairment—weakness, balance issues, speech issues, or limitations in activities—approval becomes harder. If there was a remote event with full recovery and strong current function, options may still exist, but underwriting will generally be more cautious.

Quick reference: how certain conditions are often viewed

This table is not a promise of approval, but it reflects common underwriting tendencies and how many carriers typically think about independence risk.

What carriers are really trying to avoid

Long term care insurers are primarily trying to avoid issuing coverage when there are strong near-term indicators of needing care. That often includes current assistance needs at home, frequent falls, significant balance impairment, advanced degenerative neurological conditions, or documented cognitive impairment. It can also include patterns that suggest progressive decline such as repeated hospitalizations with slow recovery or increasing reliance on family support for daily tasks.

This is why the same diagnosis can lead to different outcomes depending on functional status. Two people can both have arthritis, diabetes, and high blood pressure. One can still qualify easily while the other struggles because they’ve had multiple falls, can’t climb stairs, or need help dressing. Underwriting is not just diagnosis-based—it’s independence-based.

How to improve your chances of approval

Most people improve their approval odds by applying earlier than they originally planned. The reason is simple: underwriting is easier when you are healthier, and you usually have more carrier choices. Even small health changes that feel “normal” in your late 60s can dramatically reduce options compared to applying a few years sooner.

Accuracy matters. Long term care underwriting typically includes medication review and medical record checks when needed. Providing complete and consistent health information helps avoid delays, misunderstandings, or avoidable declines. If you’re unsure how a condition will be viewed, it is often better to frame the history clearly and show stability rather than minimizing it and creating a mismatch later.

Plan type can also matter. Traditional long term care coverage is often the most direct form of protection, but when underwriting is tight, some families explore other plan designs. If you want to compare approaches, these pages can help:

Hybrid life insurance with long-term care benefits can provide a “care or death benefit” structure.

Non-qualified long-term care annuity is often evaluated when the goal is asset repositioning with LTC protection.

LTC insurance with lifetime benefits is commonly explored by families worried about extended-duration claims.

Why working with an independent broker can change outcomes

Two applicants with similar benefits can see very different outcomes depending on which carrier they choose and how the application is positioned. Carriers do not evaluate risk identically, and small differences in underwriting philosophy can matter for certain health profiles. That is why working with an independent agency can reduce the chance of “shopping the wrong first carrier” and ending up with an unnecessary decline on your record.

At Diversified Insurance Brokers, we help you compare plan designs and carrier fit, explain the tradeoffs between premium, benefit period, elimination periods, and inflation protection, and then guide you through the process with clear expectations. The goal is clarity and efficiency—so you can choose intentionally instead of guessing.

If you want to understand long term care protection more broadly, you can start here: long term care insurance. If you want to explore an alternative structure that some families evaluate, this page is helpful: fixed annuities with long-term care benefits.