Last updated on March 1, 2025

Clients often ask us about how long-term care insurance (LTCI) companies consider applicants with recent or upcoming surgeries. As an independent brokerage dedicated to helping clients secure the right coverage, we want to shed light on how LTCI companies approach this part of the underwriting process. Understanding how insurers assess surgical history can help you plan ahead and maximize your chances of approval.

Why Surgeries Matter in LTCI Underwriting
Long-term care insurance is intended to cover future care needs, so insurers focus on assessing an applicant’s health stability and risk of needing care in the future. Surgeries–whether recently completed or scheduled–signal potential health issues that could affect your ability to live independently. Underwriters review surgeries to determine if they indicate an acute problem that’s still in recovery, a chronic condition, or a risk of complications that might lead to a claim after the policy is issued.

Recent Surgeries – Stability Periods
If you’ve had surgery recently (typically within the last 6-12 months, depending on the insurer), underwriters will look at several factors:

1. Type of Surgery

– Minor Procedures (e.g. cataract surgery or minor joint arthroscopy): These are often fine if recovery is complete and there are no ongoing issues. Many insurers approve coverage as long as you’re fully recovered, though some require a defined stability period of 3-6 months post-op.

–Major Surgeries (e.g. heart bypass or joint replacement): These surgeries will elicit more scrutiny. Underwriters want to ensure that the condition necessitating surgery is resolved or well-managed. For example, a discectomy might require 6-12 months of stability with no mobility issues. Complications from surgery will also be considered and may lengthen the required stability period.

2. Recovery Timeline: Certain insurers require a post-surgery stability stability period–often 3 to 12 months–before considering an application. This ensures there are no complications or ongoing treatments (e.g. physical therapy or opioid painkillers) which would suggest a higher risk.

3. Underlying Condition: The reason for the surgery is important. A one-time operation (e.g. appendectomy) is less concerning than surgeries for a chronic condition (e.g. rheumatoid arthritis requiring multiple joint replacements), which might signal progressive decline.

4. Current Health: Underwriters may review medical records, prescription medications, and seek to confirm you’re fully recovered and back to baseline health. They’ll also take into account your overall health and any other conditions.

For example, if you had a knee replacement 4 months ago and are now walking unaided with only occasional OTC pain relief, you’re likely insurable at several insurers. However, if you’re still in physical therapy or still on prescription pain medication, most insurers would postpone or decline your application.

Upcoming Surgeries: A Red Flag for Insurers 🚩
For all but the most minor, outpatient procedures (e.g. a dermatologic procedure), insurers are going to ask you to wait before applying. If you’re awaiting a procedure, underwriters see this as an unknown risk–your health outcome is uncertain, and the surgery might lead to complications or a need for care soon after approval.

How Insurer Guidelines Differ 📃
Every LTCI company has its own underwriting guidelines, which is where our expertise as an independent brokerage excels. For example, we know that OneAmerica is more flexible with fully-recovered clients than Nationwide, which has rigid stability period requirements.

By working with multiple carriers, we can find the best fit for your health profile, and request risk assessments prior to application to ensure we’re aligned on expectations.

Here is how several of the top long-term care insurance companies approach underwriting for surgery:

Mutual of Omaha (traditional)
– “For surgery requiring general anesthesia, planned, not completed” – decline. Wait until you’ve had the surgery and fully recovered before applying.
– Joint replacement surgery. It depends on the number of joints replaced. For “one joint after 3 months, fully recovered, no use of assistive devices, no longer receiving physical therapy” – Select rate. Two joints replaced is also fine if your height & weight are within their guidelines. More than three joint replacement surgeries would be a decline.

National Guardian Life (traditional)
NGL will assess upcoming outpatient surgical procedures on an individual basis. For upcoming surgeries requiring general anesthesia, they will decline or ask you to postpone your application.

OneAmerica (hybrid)
OneAmerica doesn’t require a specific stability period following a surgery, but does want to see that you’ve fully recovered. They will likely also request an ‘attending physician statement’ (APS), essentially your health records, to confirm the details.

An APS will also be requested if you have a history of heart bypass surgery or stents.

If you’ve fully recovered quickly after surgery, OneAmerica’s flexibility may be advantageous as opposed to the stability periods required by other hybrid carriers like Nationwide.

Nationwide (hybrid)
Here is how Nationwide approaches surgeries: “If the client has any surgery scheduled in the next six months or has been advised to have surgery, wait…until the client is at least three months postoperative, fully recovered, back to 100% activity and released from all medical and doctor’s care.”

They treat back and joint surgeries more cautiously, requiring a longer stability period:
– “Spinal and back surgeries should not be submitted prior to 12 months from completion of treatment and full recovery”
– “Surgeries and/or injection treatment for joint disorders within the past 12 months should have a prescreen completed”

Bottom line
Most LTCI carriers will recommend you wait before applying if you have an upcoming surgery requiring general anesthesia that you haven’t yet completed.

Similarly, if you’ve had a recent surgery, they’ll want to see that you’re fully recovered, and may request medical records as part of the underwriting process.

Apply early – the younger and healthier you are, the easier it is to qualify–ideally before surgeries become necessary.

As your brokers, we’ll guide you through the process, advise on timing, and recommend the insurers most likely to approve your case.

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