Understanding Mitral Valve Prolapse and Insurance

Key insight: Mitral valve prolapse (MVP), also called click-murmur syndrome or Barlow’s syndrome, is a common cardiac condition where one or both leaflets of the mitral valve bulge backward into the left atrium during heart contraction, and the vast majority of cases are benign with excellent prognosis, qualifying for preferred or standard life insurance rates.

Mitral valve prolapse occurs when the two flaps (leaflets) of the mitral valve—which controls blood flow between the heart’s upper left chamber (left atrium) and lower left chamber (left ventricle)—don’t close properly during heartbeats. Instead of closing smoothly, one or both leaflets bulge (prolapse) upward into the left atrium like a parachute. In most people with MVP, this backward billowing causes no problems and the valve still functions adequately. However, in some cases, the abnormal valve movement allows blood to leak backward from the left ventricle into the left atrium—a condition called mitral regurgitation.

The characteristic physical finding is a mid-systolic click heard through a stethoscope, which may or may not be followed by a late systolic murmur if mitral regurgitation is present. This distinctive sound—described as a “clicking” noise during heartbeat—led to the alternate name “click-murmur syndrome.” Most people with MVP are completely asymptomatic and discover their condition only during routine physical examination or cardiac testing for other reasons. When symptoms do occur, they may include heart palpitations, chest pain (typically atypical and not related to exertion), fatigue, dizziness, or shortness of breath, though many of these symptoms are now understood to be unrelated to the MVP itself and occur at similar rates in people without MVP.

The exact cause of primary MVP remains unknown in most cases—it’s considered an idiopathic condition. The valve leaflets become abnormally elastic and floppy, often with myxomatous degeneration (thickening with abnormal tissue composition). MVP can run in families, suggesting genetic inheritance, typically in an autosomal dominant pattern. MVP can also occur secondary to other conditions, particularly connective tissue disorders like Marfan syndrome or Ehlers-Danlos syndrome, where the generalized connective tissue abnormality affects the valve structure. Importantly for insurance underwriting, the distinction between isolated primary MVP (no associated syndrome) and syndromic MVP (part of broader connective tissue disorder) carries different implications for prognosis and coverage consideration.

The prognosis for most people with MVP is excellent. Large population studies have shown that asymptomatic MVP without significant mitral regurgitation carries essentially normal life expectancy. The major concern with MVP is progression to severe mitral regurgitation requiring surgical repair or replacement, but this occurs in only a small minority of cases—estimated at less than 2-3% over a lifetime for those with initially mild MVP. Risk factors for progression include classic MVP with thickened leaflets (>5mm), presence of even mild mitral regurgitation at diagnosis (which can progress over time), male gender, older age, hypertension, and increased body mass index. Regular monitoring through periodic echocardiography allows early detection if progressive regurgitation develops, enabling timely surgical intervention when needed. This generally favorable natural history is why life insurance companies view MVP so favorably when proper documentation confirms stable, non-progressive status.

Types and Classifications of MVP

Nonclassic MVP: Characterized by mitral valve leaflet displacement >2mm above the annular plane but with leaflet thickness <5mm during diastole. This represents the majority of MVP cases and carries excellent prognosis. Nonclassic MVP rarely progresses to significant mitral regurgitation and may receive no rating increase at all for life insurance—essentially treated as if you don’t have MVP. Many carriers offer preferred or preferred plus rates for nonclassic MVP without regurgitation.

Classic MVP: Defined by mitral valve leaflet displacement >2mm above the annular plane WITH leaflet thickness ≥5mm. This myxomatous degeneration of the valve leaflets carries higher risk of progression to severe mitral regurgitation over time. Classic MVP receives more conservative underwriting evaluation and typically results in at least standard rates, with table ratings applied if significant regurgitation present. However, even classic MVP with mild regurgitation and normal cardiac function usually qualifies for standard to table 2-4 ratings.

Isolated (Primary) MVP: MVP occurring without associated connective tissue disorder or other cardiac abnormalities. This represents the vast majority of cases and receives the most favorable underwriting consideration, as the condition is typically stable and not part of a progressive syndrome.

Syndromic (Secondary) MVP: MVP occurring as part of Marfan syndrome, Ehlers-Danlos syndrome, or other connective tissue disorders. These cases receive more conservative evaluation because the underlying syndrome may progress and affect multiple organ systems. The underwriting focuses as much on the systemic condition as the MVP itself, and rates depend heavily on overall syndrome severity and complications.

How Insurance Companies Evaluate MVP

Primary Underwriting Considerations

Insurance companies assess MVP applications through systematic evaluation of objective echocardiographic measurements combined with clinical assessment of symptoms and functional impact. Unlike many conditions requiring complex longitudinal analysis, MVP underwriting centers primarily on three quantifiable echo parameters that predict future complications.

Mitral Regurgitation Severity represents the most critical factor. Carriers classify regurgitation as none/trace, mild, moderate, or severe based on echocardiographic assessment of regurgitant volume and jet characteristics. No or trace regurgitation indicates the MVP is functionally insignificant—the valve is displaced but still closes adequately, preventing backward blood flow. This scenario often receives preferred or standard rates. Mild regurgitation means small amounts of blood leak backward but cardiac function remains normal. This typically results in standard to table 2 ratings. Moderate regurgitation indicates substantial backward flow requiring closer monitoring and possible future intervention, usually resulting in table 4-6 ratings. Severe regurgitation creates significant cardiac volume overload and typically requires surgical repair or replacement, often resulting in application postponement until surgery completed and recovery documented.

Mitral Valve Leaflet Thickness distinguishes classic from nonclassic MVP and predicts progression risk. Leaflets measuring <5mm indicate nonclassic MVP with minimal progression concern. Leaflets ≥5mm indicate myxomatous degeneration (classic MVP) with higher lifetime risk of requiring intervention. Carriers scrutinize classic MVP more carefully even when current regurgitation is minimal, as thickened leaflets are more likely to progress over time. However, classic MVP with stable measurements over several years provides reassurance that progression is unlikely, potentially improving rate consideration.

Left Atrial Size serves as a surrogate marker for chronic mitral regurgitation severity and duration. Normal left atrial dimensions indicate the regurgitation (if present) hasn’t caused chronic volume overload. Enlarged left atrium suggests the regurgitation has been significant enough over time to cause cardiac chamber dilation, indicating more advanced disease even if ejection fraction remains normal. Left atrial enlargement typically adds 2-4 tables to the rate classification regardless of other factors, as it indicates less favorable long-term prognosis.

Beyond these three core measurements, underwriters evaluate ejection fraction (normal >55% strongly favors approval), presence of arrhythmias (atrial fibrillation particularly concerning), symptom status (asymptomatic much better than symptomatic), medication requirements (no medications ideal; anticoagulants or anti-arrhythmics worrisome), and stability over time. Serial echocardiograms showing unchanging measurements over years provide powerful evidence of benign stable MVP, often improving rate classifications.

Coverage Outlook by MVP Severity

For more insights on how various medical conditions affect coverage decisions, see our comprehensive guide on Life Insurance Approvals with Pre-Existing Medical Conditions.

Key Underwriting Factors

Echocardiographic Measurements and Clinical Assessment

Beyond the three primary echo measurements (regurgitation severity, leaflet thickness, left atrial size), insurance underwriters evaluate numerous additional factors when assessing MVP applications. Each element contributes to the overall risk profile and influences both approval likelihood and rate classification.

Family History and Genetic Factors

MVP often runs in families with autosomal dominant inheritance patterns. Family history of MVP itself doesn’t typically worsen underwriting significantly—many family members have benign stable MVP throughout life. However, family history of severe MVP requiring surgery at younger ages, or family history of connective tissue disorders like Marfan syndrome, raises concerns about more aggressive disease and may result in more conservative rate classifications. Conversely, having multiple family members with diagnosed MVP who remain asymptomatic and complication-free into older age provides reassurance about favorable prognosis.

Optimal Timing for Applications

Required Medical Documentation

Strategies to Improve Your Application

Before Applying

Obtain Current Echocardiogram: If your last echo was more than 12-18 months ago, schedule updated testing before applying. Even if you feel fine and your physician hasn’t recommended repeat testing, having current documentation provides the objective data underwriters require. Request that the echo include specific quantitative measurements of regurgitation (not just qualitative “mild” or “moderate” description) if possible, as quantified data allows more precise underwriting assessment.

Establish Cardiology Care If Needed: For MVP beyond simple nonclassic prolapse with trace regurgitation, establishing relationship with cardiologist (even if just annual monitoring) demonstrates appropriate medical management. Cardiology notes documenting “stable benign MVP, annual monitoring appropriate, excellent prognosis” significantly strengthen applications compared to only primary care management with sporadic follow-up.

Optimize Associated Health Factors: Since MVP underwriting also considers overall cardiovascular health, optimize controllable factors like blood pressure, cholesterol, weight, and exercise habits. An applicant with MVP plus hypertension and elevated cholesterol faces compounded concerns, while an applicant with MVP but otherwise excellent health metrics may receive favorable consideration despite the MVP. Additionally, if you’ve been sedentary due to MVP-related anxiety (common with MVP misdiagnosed as more serious than it is in past decades), resuming normal exercise demonstrates the MVP isn’t functionally limiting.

Gather Longitudinal History: If you’ve had MVP for many years, compile documentation showing long-term stability. An applicant with MVP diagnosed at age 25, now age 45 with three echoes over those 20 years showing unchanged findings, presents powerfully stable disease course. Underwriters reward demonstrated long-term benign nature.

During Application

Provide Comprehensive Disclosure: Disclose your complete MVP history including how it was discovered, all testing performed, any symptoms (even if transient or resolved), any medications tried (even if discontinued), and any specialist consultations. Attempting to minimize MVP as “just a murmur, no big deal” when you actually have moderate regurgitation and take medications backfires when medical records are reviewed. Conversely, over-emphasizing benign MVP with anxiety-related symptoms unrelated to the actual valve problem can also hurt—be accurate about the cardiac status versus generalized health concerns.

Emphasize Stability and Benign Nature: When completing the application and health questionnaire, clearly communicate if your MVP is stable, non-progressive, and not functionally limiting. Frame your MVP accurately—if you have trace regurgitation and normal echo, state this rather than just “I have MVP” (which could mean anything from benign to severe). If asked about activity limitations, be truthful—most MVP causes zero functional limitation, and stating you exercise normally, work without restrictions, and have no dyspnea provides important functional assessment.

Clarify Symptom Attribution: If you have symptoms commonly attributed to MVP (palpitations, chest pain, anxiety), provide context about whether these are actually caused by the MVP or are coincidental. Many people with MVP have benign palpitations unrelated to regurgitation or valve function—if your cardiologist has documented these symptoms as not concerning and unrelated to your stable MVP, ensure this information is conveyed. Underwriters need to distinguish between symptomatic MVP indicating progressive disease versus stable MVP with unrelated benign symptoms common in general population.

Carrier Selection Strategy

Mitral valve prolapse underwriting varies substantially among carriers, with some companies having particularly favorable MVP programs while others default to conservative table ratings for any MVP beyond trace findings. For applicants with benign nonclassic MVP and no regurgitation, most carriers offer excellent rates making carrier selection less critical. However, for classic MVP with mild regurgitation, moderate regurgitation with preserved function, or post-surgical MVP, carrier selection can mean the difference between standard and Table 6 ratings.

Several major carriers have developed specific MVP underwriting protocols recognizing that most MVP is benign and doesn’t warrant substantial ratings when properly documented. These companies may offer standard rates for mild regurgitation scenarios where other carriers default to Table 2-4. Working with an independent broker who understands which carriers specialize in cardiac conditions and specifically have favorable MVP underwriting becomes invaluable for anything beyond simple benign MVP.

Our Top 10 Best Life Insurance Companies in the U.S. (2025): Expert Broker Rankings provides insights into carriers with generally favorable cardiac underwriting, though MVP-specific carrier knowledge requires specialized expertise we’ve developed through handling hundreds of valve disorder applications.

Alternative Coverage Options

When Are Alternatives Necessary?

The overwhelming majority of individuals with MVP can qualify for traditional fully underwritten life insurance at preferred or standard rates. Alternative coverage options become relevant only for severe MVP cases—those with severe regurgitation, significantly reduced ejection fraction, heart failure symptoms, post-surgical complications, or MVP associated with severe systemic connective tissue disorders. Even moderate MVP usually qualifies for table-rated traditional coverage at reasonable costs, making alternatives unnecessary.

Simplified Issue Life Insurance

For individuals whose MVP complications make traditional coverage challenging (typically Table 8+ ratings or decline), simplified issue policies provide an alternative. These policies require no medical exam and ask only limited health questions. However, most simplified issue applications include questions about heart conditions requiring medication or hospitalization, which would exclude many moderate-severe MVP cases. Simplified issue works best for mild MVP that for some reason received unfavorable traditional underwriting—perhaps due to incomplete documentation or unfavorable carrier selection—allowing a do-over without full medical underwriting.

Coverage amounts typically range from $50,000-500,000 with higher premiums than fully underwritten coverage for healthy applicants but potentially better than very high table ratings from traditional underwriting. Approval is rapid, often within days, making simplified issue useful when coverage is needed urgently.

Group Life Insurance Through Employment

Employer-sponsored group life insurance requires no medical underwriting, providing guaranteed coverage (typically 1-2x salary) to all eligible employees regardless of health conditions. For someone with severe MVP complications facing traditional insurance challenges, maximizing group coverage and any available supplemental options should be first priority. Many employers offer voluntary supplemental life insurance allowing purchase of additional amounts (often $50,000-250,000) with limited or no underwriting during enrollment periods.

Group coverage limitations include loss upon employment termination (unless portable) and limited amounts that may not meet full family protection needs. However, it provides baseline coverage without health questions, and for severe MVP cases where individual traditional coverage is extremely expensive, group coverage may represent the most cost-effective approach.

Frequently Asked Questions