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Long Term Care Blog

Arthritis and Long Term Care Insurance Underwriting

by Jack Lenenberg

Arthritis Long Term Care Underwriting

Arthritis history, for long term care insurance underwriters, is a diagnosis that must be carefully underwritten.

In recent long term care claims data prepared by the Society of Actuaries arthritis is the leading cause by diagnosis for home health care claims.  Data released by the Society states that 17% of female home care claims are for arthritis.

Arthritis is the second leading cause by diagnosis behind Alzheimer's disease for Assisted Living claims.

As such, long term care insurance underwriters exercise due diligence in approving coverage for applicants with arthritis.

How long term care insurance underwriters view arthritis

Arthritis is inflammation of one or more of your joints. Symptoms of arthritis are primarily joint pain and stiffness. These symptoms usually progress with age. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. 


Osteoarthritis is characterized by the breakdown and degeneration of joint cartilage. Osteoarthritis results from the aging process and trauma to the joint from normal wear and tear.On physical exam, the joints are tender and inflamed.  There is often joint enlargement, pain with weight bearing, and decreased range of motion. Surgery may relieve pain and restore most function.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disorder.  Rheumatoid arthritis is a chronic systemic disease that is characterized by inflammation and stiffness in the joints, but may also affect major organs within the body especially the heart and lungs.  Psoriatic arthritis shares many features with rheumatoid arthritis and carries a similar risk.  Sjogren's disease refers to symptoms of dryness in the eyes and mouth and is often seen in patients with rheumatoid arthritis.

For arthritis history, long term care insurance underwriters will seek your answers to the following questions:

When was your arthritis diagnosed?

Are you taking medication? Any narcotic medication use to control pain?

What joints are affected? Are there any joint deformities or limitations?

What is the severity (mild, moderate, severe)?

Have you received any steroid injections?

Have you received any physical therapy, joint replacements; or are any surgeries planned or recommended?

Qualifying for long term care insurance with arthritis history

To be approved for long term care insurance, underwriters will generally require that joint replacement surgery is not recommended or planned. 

If you have just completed joint surgery underwriters may require a 3 month stability period prior to accepting your application. 

Treatment with non steroidal anti-inflammatory medication (NSAIDs) is acceptable. If medications such as prednisone or methotrexate are prescribed the dosage will be important to determine your insurance approval.

Occasional narcotic medication use might be OK with some underwriters. Underwriters will decline applications if there is daily narcotic medication use. A decline is also probable if you require chronic use of a TENS unit or implantable electrical stimulator to manage pain.

Long term care insurance guidelines for arthritis do vary markedly by company.  Your application may be approved at Standard rates with one company, while approved at sub-Standard rates or declined altogether by another company.  To get approved for long term care insurance it is important to work with an independent broker that can help shop your medical records to multiple underwriters if necessary.

We are an independent agency specializing in long term care underwriting since 1998.  Should you wish to review your health history, receive quotes or get approved for coverage please do not hesitate to contact us at (800) 891-5824. 

Or complete our long term care insurance quote request form.  We will send you side-by-side comparison costs of the leading companies including Mutual of Omaha, National Guardian, Mass Mutual, Mutual of Omaha, Transamerica, Lincoln Financial, Pacific Life, State Life and more.

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