CPAP & Long-Term Care Insurance

A friend was applying for Long Term Care Insurance, and was surprised to learn that there was an automatic exclusion on a standard policy for anyone who was using a CPAP. Fortunately, his doctor had told him that everyone who was referred for possible CPAP evaluation had been told that they needed one, and that the evaluation companies made most of their money from the devices more than the evaluation, so he had never gone for an evaluation. Of course, it could have been a life-threatening decision if indeed one was necessary.

Jasmo said:

A friend was applying for Long Term Care Insurance, and was surprised to learn that there was an automatic exclusion on a standard policy for anyone who was using a CPAP. Fortunately, his doctor had told him that everyone who was referred for possible CPAP evaluation had been told that they needed one, and that the evaluation companies made most of their money from the devices more than the evaluation, so he had never gone for an evaluation. Of course, it could have been a life-threatening decision if indeed one was necessary.

The evaluation at St. B. was over $6,000. Medicare and secondary paid all but $15.00. There are "stand alone" centers that may be less expensive.

Just to clarify, the concern was that anyone who applies for long-term care insurance is automatically excluded if he or she uses or has been diagnosed as needing a CPAP.

I didn't know that Long-term care insurance even existed anymore.

Assume this applies to new applications only. Once someone has a fully paid policy, I can't see this exclusion being added after the fact.

I have seen at home sleep study gadgets that connect to a smart phone...maybe start with that.

I have used a bi-PAP machine regularly for at least 15 years and have had long term care insurance for about 8 years. The question was never raised when I first got the policy. Just trying to think logically, why would an insurance carrier not insure a person using life saving equipment?

Perhaps the policies have changed as the result of updated actuarial tables. My hunch is that some people who need the devices, order them and then don't use them regularly or at all, putting them at higher risk for later problems. Of course, if one waits for an evaluation until after getting the insurance, then they can no longer be excluded.

kmk said:

I didn't know that Long-term care insurance even existed anymore.

Many of us are grandfathered in with insurers who stopped writing new policies long ago. I am grateful for it.

Why would CPAP usage be sngled out? How would that be substantively different than, say, taking meds for cholesterol or high blood pressure?

mumstheword said:

Just trying to think logically, why would an insurance carrier not insure a person using life saving equipment?

Pretty sure LTC insurers don't want you to save your life. Your longevity is unprofitable for them.

But not having it could cause a lot more catastrophic care.

I've heard that the non-compliance rate for CPAP usage is at about 50%. Not using a CPAP when one is needed can lead to a great many health issues, which would obviously add to the cost of long term care if or when needed. So when insuring people if the person needed a CPAP there assuming the non-compliance rate was accurate there would be a 50% chance that they didn't use it and were therefore more likely to need more expensive healthcare down the road.