COPD, emphysema and life insurance

Where this sits

Chronic obstructive pulmonary disease covers emphysema and chronic bronchitis. Unlike asthma, it is progressive, and underwriters treat it accordingly.

That does not mean coverage is unavailable. Mild disease with good lung function in someone who stopped smoking years ago is regularly insurable, sometimes at reasonable terms. Moderate disease attracts substantial ratings. Severe disease, particularly with oxygen dependence, is where full underwriting often stops being available and the no-medical products become the practical route.

The spread across that range is large, and the two things that move an applicant along it are lung function and smoking status.

The number that matters

Lung function testing, usually spirometry, produces a measurement of how much air you can force out in one second, reported as FEV1 and expressed as a percentage of what would be expected for someone your age, height and sex.

This is the most influential single item in a COPD file. It gives an underwriter an objective measure of severity rather than a description, and it is comparable across applicants in a way that symptoms are not.

If you have had spirometry, the result is in your records. Knowing roughly where you sit is worth doing before applying, because it tells you what kind of conversation to expect.

Where testing has been repeated over years, the trend matters too. Stable readings over time read very differently from a declining series.

Smoking status is the factor you can affect

Of everything on this page, this is the one that moves outcomes most and the one applicants have any influence over.

COPD is most commonly associated with smoking, and continued smoking is associated with faster progression. Underwriters know this and weight it heavily.

Someone with COPD who stopped smoking several years ago and whose lung function has been stable since is in a genuinely different position from someone with the same measurements who still smokes. Many insurers will make an offer in the first case and decline in the second.

How long ago you stopped matters, and it is usually documented in your records. Cotinine testing at a paramedical shows the current position regardless of what the application says. See smokers, vaping and nicotine testing.

Anything you decide to do about smoking is a matter for you and your doctor, and it has consequences far more important than an insurance application.

Flare-ups

Exacerbations are episodes where symptoms worsen beyond the usual level. Underwriters count them, and three things matter.

How often they happen. Occasional flare-ups managed at home sit differently from several a year.

Whether they need oral steroids or antibiotics, which marks them as more significant.

Whether any required emergency attendance, hospital admission, or ventilation. An admission for a COPD exacerbation is a serious marker, and a recent one will often produce a postponement.

A record showing no exacerbations over a period of years is a strong item in the file.

Oxygen

Requiring supplemental oxygen indicates advanced disease and substantially narrows what is available. Most fully underwritten offers stop being made at that point.

Where that applies, the practical options are simplified issue products, whose short questionnaires frequently include a direct question about oxygen use, and guaranteed issue products, which ask nothing about health but carry smaller amounts and a waiting period at the start.

Coverage remains obtainable. It is smaller and more expensive, and it is still coverage.

What accompanies it

COPD often shares its risk factors with cardiovascular disease, so it is common to see both. Where coronary artery disease is also present, the assessment reflects both, on the terms in coronary artery disease.

Build, sleep apnea and general exercise tolerance also feed in, and a physician’s note describing what you can do day to day carries genuine weight here.

Applying

Have your most recent spirometry result if you know it, when you were diagnosed, what medication you take, how many flare-ups you have had and whether any needed hospital care, whether you use oxygen, and your smoking history including the date you stopped if you have.

Apply fully underwritten first even where you expect a difficult answer. Insurers vary on COPD, particularly in the mild to moderate range and for former smokers, and one decline is not the market’s answer. See declined or postponed.

The boundary

This page is about how insurance applications are assessed. It is not information about COPD, its treatment or its management, and nothing here is a recommendation about medication, oxygen or anything else clinical. That belongs entirely with your respirologist or family doctor.