First, what is actually true about this

Underwriting for a standalone long-term care policy is strict. It looks at your health history, your mobility, your cognition and your medications, and the insurer decides. Nobody — not us, not any agent, not any website — can tell you in advance that you will be approved, or that you will be declined. What we can tell you is that a rider on a life policy or an annuity is sometimes available where a standalone policy is not, and that the two are underwritten separately. A decline in one place is not a verdict everywhere.

If you have not yet applied and are trying to judge your odds, the health factors involved are on what disqualifies you from long-term care insurance. This page is about what comes next.

Why it matters that you find something

Because the exposure does not go away when the application does. The U.S. Department of Health and Human Services projected in its 2022 research brief that 56% of Americans turning 65 today will develop a disability serious enough to require long-term services and supports, for an average of 3.1 years — 3.6 years for women and 2.5 years for men. 22% of adults, about one in five, will need help for more than five years.

The 2025 CareScout Cost of Care Survey, released in March 2026, puts the national medians at $355 a day for a private nursing home room — $129,575 a year — $315 a day semi-private, $6,200 a month for assisted living, $35 an hour for a non-medical caregiver at home, and $95 a day for adult day health care. HHS put the average future cost for a person turning 65 today at $120,900, of which families pay 37% out of pocket, averaging $44,800, and 14% of people spend at least $100,000 of their own money.

And the coverage most people assume will catch them does not. Medicare does not pay for long-term custodial care when help with daily living is the only care needed.

Option one: a rider on a life insurance policy

Life insurance is underwritten on its own terms, and a long-term care or chronic illness rider attached to it is a different application from a standalone long-term care policy. Benefits generally come out of the death benefit, so paying for care reduces what beneficiaries receive — and if care is never needed, the death benefit is paid as it always would have been.

Start with what a long-term care rider is, then follow the money through a claim on how life insurance with a long-term care rider works.

Option two: a hybrid or linked-benefit contract

Contracts built around the combination from the outset — often funded with a single premium or a short run of premiums — are sold as hybrid, linked-benefit or asset-based long-term care. They are covered on hybrid long-term care insurance. The appeal for someone who has been turned down elsewhere is not only underwriting; it is that the money is not wasted if care is never needed.

Option three: an annuity with a care benefit

If the obstacle is health rather than money, an annuity with a long-term care rider is worth a look, because it repositions a sum you already have rather than asking for a new annual premium. The mechanics, the statutory trigger and the trade-offs are on whether an annuity can have a long-term care rider. It is still underwritten, and the insurer still decides.

What the trigger will be, whichever route you take

On any qualified long-term care benefit, the gate is the same one, set by 26 U.S.C. §7702B(c)(2). A licensed health care practitioner must certify that you are unable to perform, without substantial assistance from another person, at least 2 of the 6 activities of daily living for at least 90 days because of a loss of functional capacity — or that you require substantial supervision to protect you from threats to health and safety because of severe cognitive impairment. A similar level of disability determined under Treasury regulations also qualifies, and the certification must have been made within the preceding 12 months.

The six activities named in the statute are eating, toileting, transferring, bathing, dressing and continence, and a contract's own test must take at least 5 of the 6 into account.

One warning for anyone shopping in a hurry after a decline. Some contracts offer a §101(g) chronic illness rider instead of a §7702B long-term care rider. A policy carrying only a 101(g) rider cannot hold itself out as offering a long-term care benefit, and that rider generally requires the condition to be permanent. Ask which section the rider is written under before you sign anything — the comparison is on long-term care rider versus chronic illness rider.

Option four: a smaller plan, honestly built

If nothing with full coverage is available, partial funding is not failure. A benefit that covers a meaningful share of a $6,200-a-month assisted living median, or that pays for a non-medical caregiver at $35 an hour for part of the week, changes what a family can manage. HHS also found that the average length of paid long-term services and supports is just under one year — much of the 3.1-year average is unpaid care given by family. Funding even that paid year moves the problem.

Option five: self-funding, with an actual number attached

Deciding to pay for care out of your own assets is a legitimate strategy and a terrible slogan. It only counts as a plan if you know which account it comes out of, what it does to a surviving spouse, and whether it survives the long tail. Against a $120,900 average, a one-in-seven chance of spending $100,000 or more yourself, and a 22% chance of needing care for more than five years, “we will manage” is a sentence, not a number.

Where Medicaid sits, said once and plainly

Medicaid is the largest single payer for long-term services and supports — HHS puts its share at 43% of all such costs, averaging $51,800, and 52% of costs in institutional settings. It is a program for people whose income and assets are already low. The Jordan Insurance Agency does not sell or advise on Medicaid. We name it because it is the honest answer to who pays when nothing was arranged.

The tax rules that apply either way

For 2026 the IRS per diem limitation for periodic payments from a qualified long-term care contract is $430 a day, under §7702B(d)(4) as stated in Revenue Procedure 2025-32 at §3.62. The 2025 figure was $420. The $440 figure circulating on secondary sites is wrong for 2026, and the statute's own $175 is the 1997 base amount, indexed ever since under §7702B(d)(5).

The same revenue procedure at §3.27 caps how much qualified long-term care premium counts as a medical expense per insured person for 2026, by attained age at the close of the tax year: $500 at 40 or less, $930 for 41 to 50, $1,860 for 51 to 60, $4,960 for 61 to 70 and $6,200 over 70. Medical expenses are deductible only as an itemized deduction and only above 7.5% of adjusted gross income. We state the Code; your tax professional applies it.

What not to do

Do not assume one decline closes the subject — companies and products underwrite differently. Do not buy the first thing offered afterwards, which is when people are likeliest to accept a contract they have not read. Do not treat a chronic illness rider as long-term care coverage. And do not let a year pass while you think about it: every route on this page is medically underwritten.

How The Jordan Insurance Agency helps

This is the situation we are most useful in, and it is also where an independent agency matters most. We look at what was declined and why, which companies and which products underwrite that condition differently, and whether a rider or a hybrid is realistic for you. We read the contract language rather than the brochure — which section the rider is written under, what the activities-of-daily-living test requires, how benefits are paid, what is left for beneficiaries. And we will tell you when the honest answer is a smaller plan, or self-funding with a number attached, rather than a policy. What we will never do is tell you that you qualify. Underwriting decides that, every time.

The Jordan Insurance Agency is an independent, licensed insurance agency based at 3540 Toringdon Way, Suite 200, Charlotte, NC 28277. You can reach us at (704) 926-7565, Monday through Friday, 9:00 AM to 5:00 PM Eastern. Because we are independent we represent multiple carriers rather than one, and we read the contract language rather than the brochure. A consultation with a licensed agent is free.