Results of a study published in the Journal of Law, Medicine & Ethics indicate that individuals who have knowledge of their Alzheimer disease biomarker status may possibly be exposed to adverse long-term care insurance coverage decisions.

Jalayne J. Arias, JD, MA, of the Department of Neurology at the University of California San Francisco, and colleagues used empirical legal research methods to evaluate state law practices and determine whether patients who learn their AD biomarker status are protected from discriminatory coverage decisions based on that status.

Approximately 5.5 million Americans have AD or dementia; this number is expected to reach nearly 14 million by 2050. Only 10% of Americans between the age of 60 and 65 have long-term care insurance. This low level of coverage may be due in part to the misconception that Medicare or other health insurance covers long-term care services and support for the elderly, the high cost of premiums, and the denial of coverage by long-term care insurers — up to 24% of applications based on medical underwriting.

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The investigators determined that the National Association of Insurance Commissioners (NAIC) Model Act has few sections that address unfair or discriminatory practices. Although this act prohibits insurers from terminating a policy following enrollment, it provides insurers with the ability to rescind a policy for misrepresentation on an application within 6 months of the policy.

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The researchers found that most state laws were consistent with the NAIC Model Act.  In 43 states, long-term care insurers are allowed to use health information for underwriting decisions, and the study contends that the provisions of the NAIC Model Act and state laws do not provide meaningful protections for individuals who learn their biomarker status. This would prevent patients who are biomarker-positive from preparing for the burden of long-term care services and support costs.

The investigators argued that this constitutes a critical gap in anti-discrimination protections. However, they admitted that allowing individuals to learn their biomarker status while keeping this information from long-term care insurers would increase the likelihood of individuals waiting until they see a need for a policy to purchase one.

The researchers called for a reevaluation of the underwriting standards to promote access to long-term care coverage.


Arias JJ, Tyler AM, Oster BJ, Karlawish J. The proactive patient: long-term care insurance discrimination risks of Alzheimer’s disease biomarkers. J Law Med Ethics. 2018;46:485-498.