Can’t qualify for long-term care due to health issues…What do I do?

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Morning, Toni:

Recently, you wrote a Medicare column about various life policies available after 65, and I have a retirement insurance question.

In June, I’m retiring when I turn 70 and my wife, Anna, will be 68. Our retirement insurance issue is that recently we applied for a long-term care plan and were both denied due to our health issues. I had my prostate removed due to cancer for about 5 years with no current issues and Anna has AFib that is under control. The agent writing the long-term care plan said that those past 60 years old find it difficult being accepted by an LTC plan due to health issues like we have.

My brothers and I are paying an Alzheimer’s assisted living facility more than $12,000 a month for our father’s care. Are there long-term care options available for Anna and me with our health issues? Paying $12,000 a month will drain our retirement.

Thanks, Paul 

Hi Paul:

I’m glad that my article about life insurance plans past 65 caught your attention and you took the time to email me about your long-term care situation. New short-term care plans that have extended care benefits have been developed assisting baby boomers when there is a need for extra help with unexpected health or accident issues.

On page 56 of 2026 Medicare & You handbook, under “Paying for long-term care,” discusses how important it is to plan properly to maintain your independence and receive the proper care in the facility you want. Medicare only pays for medically necessary skilled nursing facility care or for home health care if you meet certain conditions. Skilled nursing facility care, discussed on page 29 of the handbook, has 100 days of benefit with days 1-20 having a $0 copay per day after you pay the Part A deductible, which is $1,736 per benefits period for 2026, and days 21-100 having a copay per day of $217 in 2026. If you cannot qualify or do not meet Medicare’s qualification for skilled nursing, you will pay 100% of the cost out of your pocket. Medicare doesn’t cover non-medical long-term care. This is why buying a policy to help with a long-term need becomes essential.

Let’s discuss three options that can help to protect your finances from excessive long-term care costs, especially if you have health issues that can keep one from being accepted by a long-term care plan.

• Short-term care insurance plans have a simple health questionnaire with yes/no questions, making it easy to qualify. These policies will help paying for nursing home, assisted living and personal care home as facility care with benefits for care in your house when you want to stay home for care. STC offers various options ranging from $50-$400 per day with benefit periods ranging from 1 or 2 years. Allowing one to not drain their retirement dollars due to recovery from a fall or serious illness.    
• Life and Annuity Policies are insurance policies that have a provision if you need long-term care; you can receive a certain amount of long-term care with your life/annuity policy’s face (Health questions may keep one from qualifying.)
• Aid and Attendance benefits is a VA benefit that can help wartime Veterans or surviving spouses with long-term care issues. There is over $20 Billion dollars available for long term care pension money just waiting for America’s Veterans. Visit http://www.va.gov/pension/aid-attendance-housebound to apply and view if you can apply.  There must be a long-term care issue for one to qualify.

Important: If you are under 60 and in good health, please take your time to apply for a traditional long-term care policy. This makes it easier to qualify and receive a lower premium whether annual or monthly. Most Americans retiring are concerned about a chronic illness being their biggest retirement expense if not planned for properly.

If you have long-term care or Medicare questions, please feel free to reach out to the Toni Says Medicare team at 832/519-8664 or send an email to [email protected].

Toni’s new course, a downloadable video series called the “Confused about Medicare Workshop” and the “Medicare Survival Guide Advanced” edition are available at www.tonisays.com. 

Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.

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Toni King is an author and columnist on Medicare, Social Security, and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email [email protected] or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.