About the Author

The Insurance Brokers USA Team consists of licensed insurance professionals with extensive experience helping clients with complex health conditions find appropriate coverage. Our agents have worked with hundreds of individuals facing cardiac valve challenges, specializing in alternative insurance solutions when traditional coverage isn’t available.

What Is Aortic Insufficiency and How Do Insurers View It?

Aortic insufficiency, also called aortic regurgitation, occurs when the aortic valve fails to close completely, allowing blood to leak backward from the aorta into the left ventricle during diastole. This backward flow forces the left ventricle to work harder, pumping both the normal forward volume plus the regurgitant volume with each contraction. Over time, this volume overload can lead to left ventricular dilation, dysfunction, and eventually heart failure if left untreated.

The clinical significance of aortic insufficiency varies dramatically based on severity and duration. Mild aortic regurgitation discovered incidentally may never progress or cause symptoms, while severe acute regurgitation constitutes a medical emergency. Insurance underwriters approach evaluation with sophisticated understanding of these distinctions.

Severity Grading and Underwriting Impact

Life insurance companies categorize aortic insufficiency based on echocardiographic severity grading, as different grades carry vastly different prognoses:

• Mild aortic insufficiency (Grade 1): Minimal regurgitant volume with normal left ventricular size and function. This represents the most favorable category for insurance purposes. Many individuals with mild AI discovered incidentally during routine evaluation receive standard or near-standard rate approvals, particularly when the underlying cause is benign (such as mild aortic root dilation or bicuspid valve without other complications) and no symptoms exist.
• Moderate aortic insufficiency (Grade 2): Intermediate regurgitant volume that may cause mild left ventricular dilation over time. Underwriting outcomes depend heavily on left ventricular response, symptom status, and underlying etiology. Well-compensated moderate AI with normal or near-normal LV dimensions and good exercise tolerance often qualifies for Table 2-6 ratings, while progression toward severe disease or early LV changes results in more conservative underwriting.
• Severe aortic insufficiency (Grade 3-4): Substantial regurgitant volume requiring close monitoring or intervention. Severe AI presents challenging underwriting scenarios, with outcomes depending primarily on left ventricular compensation, symptom burden, and treatment planning. Asymptomatic severe AI with preserved LV function may qualify for heavily rated coverage, while symptomatic severe AI or significant LV dysfunction often faces traditional underwriting declines, making alternative coverage options necessary.

Common Causes and Their Insurance Implications

Underwriters investigate the underlying cause of aortic insufficiency as carefully as they evaluate the hemodynamic severity, since etiology provides prognostic information and signals potential associated conditions.

Bicuspid aortic valve: The most common congenital heart defect, affecting approximately 1-2% of the population. Bicuspid valves can develop regurgitation, stenosis, or both over time. When AI results from bicuspid valve without associated aortic root disease or significant hemodynamic compromise, underwriting outcomes can be favorable. However, underwriters also consider associated conditions like aortic coarctation or aneurysm that sometimes accompany bicuspid valves.

• Aortic root dilation: Enlargement of the aortic root prevents proper valve leaflet coaptation. This can result from hypertension, aging, connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome), or idiopathic causes. The presence of significant aortic aneurysm alongside AI complicates underwriting substantially, as aneurysm size and growth rate become additional risk factors requiring evaluation.
• Rheumatic heart disease: Though less common in developed countries, rheumatic fever can damage heart valves. Rheumatic AI often coexists with mitral valve disease, complicating the underwriting picture with multiple valvular lesions.
• Endocarditis: Infection of the heart valves can cause acute severe regurgitation or chronic valve damage. History of endocarditis raises underwriting concerns about recurrence risk and extent of cardiac damage, though successfully treated remote endocarditis with stable residual mild-moderate AI can receive reasonable consideration.
• Degenerative changes: Age-related valve degeneration represents a common cause of mild AI in older adults. When degenerative AI remains mild without progression and LV function stays normal, underwriting impact may be minimal.

What Factors Affect Your Application?

Key insight: Underwriters evaluate aortic insufficiency through comprehensive hemodynamic and clinical assessment that examines the interaction between valve dysfunction and ventricular response. Your approval likelihood and rate classification depend on multiple factors that together predict long-term prognosis.

Left Ventricular Size and Function

The most critical underwriting determinant is how well your left ventricle has compensated for the volume overload imposed by aortic regurgitation. This assessment forms the foundation of risk stratification.

Echocardiographic measurements showing: Normal left ventricular end-diastolic and end-systolic dimensions, preserved ejection fraction (typically 55% or higher), and absence of significant hypertrophy create the most favorable underwriting scenario. These findings indicate successful ventricular compensation despite regurgitant volume, suggesting low risk of progression to heart failure.

Concerning findings include: Left ventricular dilation beyond normal limits, reduced ejection fraction below 50%, progressive chamber enlargement on serial studies, or development of significant hypertrophy. These changes signal inadequate compensation and substantially increase risk of adverse outcomes, resulting in conservative underwriting approaches or traditional declines necessitating alternative coverage options.

Symptom Status and Exercise Capacity

The presence or absence of symptoms provides crucial prognostic information independent of objective measurements. Symptomatic aortic insufficiency signals more advanced disease and poorer prognosis than asymptomatic AI with similar hemodynamic severity.

Classic symptoms of decompensating AI include exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, and angina. Development of these symptoms typically indicates need for surgical intervention and represents a turning point in the natural history of the disease. For insurance purposes, symptomatic AI faces substantially more conservative underwriting than asymptomatic disease with similar severity.

Exercise testing provides objective assessment of functional capacity. Normal exercise duration, appropriate heart rate and blood pressure response, and absence of symptoms during exertion all suggest good compensation and favorable prognosis that influences underwriting decisions positively.

Treatment Status and Surgical History

Whether you’ve undergone valve replacement surgery dramatically influences underwriting approach and outcomes. The timing and results of surgical intervention provide important prognostic information.

Successful aortic valve replacement: Patients who have undergone successful valve replacement (either mechanical or bioprosthetic) with good post-operative recovery can achieve favorable underwriting outcomes. Key factors include time since surgery (typically require 6-12 months post-op for optimal rates), normal post-operative LV function, absence of complications, and appropriate anticoagulation management if mechanical valve was placed. Many individuals 1-2 years post-successful valve replacement qualify for Table 4-8 ratings depending on age, valve type, and overall cardiac status.

Medical management without surgery: Mild to moderate AI being monitored without surgical intervention can receive excellent underwriting consideration when LV compensation remains good and no progression occurs. Close cardiology follow-up with serial echocardiograms demonstrating stability supports favorable classification.

Awaiting surgical intervention: Individuals with severe AI awaiting scheduled valve replacement face challenging underwriting, as they’re in the period of highest risk before definitive treatment. Most carriers postpone decisions until post-operative recovery is complete, though some alternative products may provide limited coverage during the interim period.

What Coverage Options Are Available?

Individuals with aortic insufficiency access life insurance through several pathways, each offering distinct advantages depending on disease severity, left ventricular status, and overall cardiac profile. Strategic selection of appropriate coverage type optimizes approval likelihood and cost-effectiveness.

Traditional Fully Underwritten Policies

These policies require comprehensive medical evaluation including physical examination, laboratory testing, and detailed health documentation review. For individuals with mild to moderate aortic insufficiency and documented normal or near-normal left ventricular function, traditional underwriting often produces the most favorable outcomes.

Best candidates include: Applicants with mild AI (Grade 1) and normal LV dimensions and ejection fraction, moderate AI (Grade 2) with preserved LV function and no symptoms, or successful valve replacement 1+ years post-operative with good recovery and stable cardiac function. These individuals frequently qualify for standard to Table 6 ratings depending on specific circumstances and age.

When pursuing traditional life insurance with pre-existing medical conditions, comprehensive documentation becomes essential. Complete echocardiographic reports, cardiology consultation notes, and serial studies demonstrating stability significantly improve approval odds and rate classifications.

Simplified Issue Policies

These products eliminate medical examinations while requiring health questionnaires. The specific questions about valve disease and cardiac conditions vary substantially between carriers, creating strategic opportunities for applicants whose AI is clinically stable but might trigger conservative traditional underwriting.

Simplified issue works particularly well for individuals with mild AI discovered incidentally who might face questions and ratings in traditional underwriting despite excellent prognosis, or for those 1-2 years post-valve replacement who prefer to avoid detailed cardiac scrutiny while establishing a longer track record of post-operative stability.

Many individuals find that no-exam life insurance companies provide accessible coverage when their aortic insufficiency is well-managed, but the traditional underwriting process becomes overly complex due to surgical history or multiple cardiology consultations.

Guaranteed Issue Life Insurance

These products accept all applicants within specified age ranges regardless of health status. While premiums are substantially higher and death benefits are limited, guaranteed issue policies provide approval certainty for individuals with severe AI, significant LV dysfunction, or complex cardiac histories, including multiple valve diseases or prior heart failure.

Guaranteed issue becomes particularly relevant when traditional underwriting would result in a decline due to severe regurgitation with poor LV compensation, or when multiple cardiac conditions create prohibitively complex risk assessment. Many families strategically combine guaranteed issue coverage with other policy types to maximize total protection.

For older applicants primarily focused on covering funeral expenses and final medical bills, final expense insurance companies offer guaranteed issue products specifically designed for end-of-life cost coverage with manageable premium structures and streamlined approval.

Group Life Insurance Through Employment

Employer-sponsored group life insurance typically provides guaranteed issue coverage up to specified limits without medical underwriting. This represents the most accessible option for individuals with aortic insufficiency, particularly those with severe disease or LV dysfunction who would face traditional underwriting challenges.

The primary limitation involves portability – group coverage terminates when employment ends, creating potential coverage gaps if health has deteriorated. Maximizing group coverage while simultaneously securing portable individual coverage when health permits provides an optimal protection strategy.

How Can You Strengthen Your Application?

Key insight: The difference between standard rates and heavy table ratings or declines often results from documentation quality, application timing, and strategic carrier selection rather than actual hemodynamic differences. Proactive preparation dramatically improves outcomes for applicants with aortic insufficiency.

Gather Comprehensive Medical Documentation

Underwriters base decisions on the evidence you provide. Incomplete valve disease documentation forces conservative assumptions that work against your approval odds. Before applying, compile complete records including:

• Recent comprehensive echocardiogram report demonstrating: Specific quantification of AI severity (effective regurgitant orifice area, regurgitant volume, regurgitant fraction), left ventricular dimensions (end-diastolic and end-systolic diameters), ejection fraction calculation, assessment of other valves, and interpreting cardiologist’s summary. Recent studies (within 6-12 months) carry more weight than older reports, particularly for demonstrating stability.
• Serial echocardiograms showing stability or improvement: Comparison reports demonstrating stable valve function and LV dimensions over time provide powerful evidence of good compensation and low progression risk. Progressive worsening on serial studies raises underwriting concerns even when current severity remains moderate.
• Exercise stress test or cardiopulmonary exercise testing results: Objective exercise capacity measurement, hemodynamic response to exertion, presence or absence of symptoms during exercise, and overall functional assessment. Normal exercise testing despite valve disease strongly supports a favorable underwriting classification.
• Cardiology consultation notes explaining: The underlying cause of AI, treatment recommendations (medical management versus surgical referral timing), prognosis assessment, follow-up plans, and activity recommendations or lack of restrictions. Clear cardiologist statements about stable mild-moderate disease with excellent compensation significantly influence underwriting decisions.
• Surgical records if valve replacement was performed: Operative reports detailing procedure specifics, post-operative echocardiograms showing prosthetic valve function, recovery course documentation, and follow-up assessments confirming good outcome. Successful surgery with excellent recovery substantially improves long-term insurability.

Time Your Application Strategically

Application timing significantly impacts outcomes, particularly following diagnosis changes or surgical intervention. Consider these timing factors:

• For newly diagnosed AI, waiting until comprehensive evaluation is complete, including echocardiography and cardiology consultation, provides underwriters with a definitive assessment rather than preliminary findings. This typically requires 1-3 months from initial discovery.
• Following aortic valve replacement, waiting 6-12 months post-operatively allows for complete recovery, demonstration of good prosthetic valve function, and resolution of any post-operative complications. Applying too soon after surgery results in conservative underwriting due to uncertain long-term outcomes.
• When AI severity is borderline (between moderate and severe), having recent echo confirmation before applying prevents underwriters from assuming worst-case scenario. If your cardiologist mentions potential progression, waiting for follow-up studies that demonstrate stability improves application outcomes.
• After medication changes for blood pressure control or other optimization, allowing 3-6 months to demonstrate treatment effectiveness and stable cardiac status provides favorable evidence rather than uncertain transition period data.

Work With Specialized Brokers

Independent brokers with expertise in cardiac valve disease understand which carriers offer the most favorable underwriting for aortic insufficiency cases at different severity levels. This specialized knowledge prevents unnecessary declines by directing applications to companies with appropriate risk appetite for valvular disorders.

Specialized brokers provide pre-underwriting case assessment, identifying potential obstacles before formal application. This preview allows you to address documentation gaps, optimize timing, or consider alternative coverage approaches before underwriting review creates permanent records of declined or heavily rated applications.

When evaluating options, ensure you’re working with someone who understands the complete landscape of the best life insurance companies for valve disease, not just those with aggressive marketing or the highest commission structures that may not offer optimal underwriting for your specific cardiac profile.

What Will Life Insurance Cost?

Premium costs for individuals with aortic insufficiency vary substantially based on severity grade, left ventricular compensation, surgical history, age, coverage amount, and policy type selected. Understanding realistic cost expectations helps you budget appropriately and evaluate whether quoted premiums align with industry norms.

Rate Classifications and Premium Impact

Life insurance companies assign rate classifications that determine premium multipliers above standard rates. For aortic insufficiency cases, possible classifications include:

• Standard to Table 2 rates: Achievable for mild AI (Grade 1) with normal LV dimensions and ejection fraction, no symptoms, and stable disease on serial studies. Some younger applicants with truly trivial AI discovered incidentally may qualify for standard rates, while most mild AI cases receive Table 2 classification, representing a 25-50% premium increase above standard.
• Table 2-6 ratings: Common for moderate AI (Grade 2) with preserved or minimally dilated LV, mild symptoms or asymptomatic status, and appropriate cardiology follow-up. Also, typical for post-valve replacement patients 1-2 years post-operative with excellent outcomes. Premium increases range from 25% to 150% above standard rates depending on specific table assigned.
• Table 6-10 ratings: Applied for moderate-severe AI with mild LV dilation but preserved ejection fraction, or severe AI that is asymptomatic with close monitoring, or post-surgical patients with complications or suboptimal outcomes. Premium increases reach 150% to 250% above standard rates at these levels.
• Declines or Table 10+ ratings: Expected for severe AI with significant LV dilation, reduced ejection fraction below 45%, symptomatic disease, or multiple valve involvement with overall moderate-severe burden. At these levels, guaranteed issue products often provide better value than heavily rated traditional policies if available.

Cost Comparison by Coverage Type

Different policy types carry distinct cost structures that may advantage specific applicants depending on their valve disease profile and coverage requirements.

Traditional term life insurance: Offers the most affordable premiums for applicants who qualify at reasonable rates, but costs escalate quickly with table ratings. Term insurance remains the most cost-effective option for mild AI cases receiving standard to Table 4 ratings, providing maximum coverage per premium dollar.

Simplified issue policies: Carry higher base premiums than traditional policies but don’t apply medical ratings, making them economically attractive when traditional underwriting would result in Table 6+ ratings. For borderline cases, comparing simplified issue premiums to projected rated traditional costs often reveals simplified issue provides better value.

Guaranteed issue coverage: Features the highest per-dollar cost but provides approval certainty for individuals with severe AI or significant LV dysfunction. These products make sense when traditional coverage isn’t accessible and some coverage exceeds no coverage, particularly for final expense needs.

Strategies to Minimize Costs

Several approaches help reduce life insurance expenses while maintaining appropriate coverage:

• Maximize group life insurance through employment, which provides guaranteed issue coverage regardless of valve disease severity. Many employers offer coverage equal to 1-2 times salary at minimal cost, reducing individual coverage needs.
• Consider term insurance rather than permanent policies for pure protection needs, as term provides maximum death benefit per premium dollar even with rating applied. This becomes particularly important when ratings increase costs substantially.
• If post-valve replacement, applying after sufficient recovery time (12+ months) but before developing any complications optimizes the balance between demonstrating good outcome and minimizing rating duration.
• For mild AI, applying while cardiac function is definitively normal rather than waiting for potential progression preserves access to best possible rates. Delaying application doesn’t prevent AI from progressing but may result in worse rates later.

Which Companies Offer the Best Outcomes?

Life insurance carriers demonstrate substantial variation in their approach to valvular heart disease underwriting. Some companies maintain extremely conservative cardiac guidelines that automatically decline or heavily rate any valve disorder regardless of severity, while others employ sophisticated assessment that distinguishes between benign compensated disease and hemodynamically significant pathology.

Carrier Characteristics That Favor AI Cases

Companies most likely to provide favorable underwriting for individuals with aortic insufficiency typically share several characteristics:

• Sophisticated valve disease protocols that evaluate hemodynamic significance: Progressive carriers distinguish between trivial-mild AI requiring no intervention and moderate-severe disease. They recognize that regurgitation severity matters less than ventricular compensation, examining LV dimensions and function carefully rather than declining based on diagnosis alone.
• Recognition that valve surgery can restore a reasonable risk profile: Forward-thinking carriers treat successful valve replacement as corrective intervention rather than permanent cardiac impairment. They apply reasonable ratings (typically Table 4-8) for good surgical outcomes rather than automatic declines based on valve replacement history.
• Willingness to consider serial studies demonstrating stability: The most favorable carriers value longitudinal data showing stable valve function and LV dimensions over years, recognizing this pattern indicates low progression risk that merits better classification than a recent diagnosis without a track record.
• Access to experienced medical directors for complex cases: Companies with strong medical director involvement can make nuanced decisions about borderline cases, often resulting in approval with rating rather than decline for moderate-severe AI with preserved LV function.

Strategic Application Placement

Applying to companies with appropriate cardiac underwriting sophistication prevents unnecessary declines and optimizes rate classification. Key strategic considerations include:

• Target carriers known for nuanced valve disease underwriting rather than those with one-size-fits-all cardiac restrictions. The companies most heavily advertised to general consumers often maintain the most conservative medical underwriting.
• Consider carriers specializing in rated cases when your AI clearly requires table rating. Some companies rarely rate policies, while others have extensive experience with cardiovascular ratings, making the latter more likely to apply reasonable rather than prohibitive ratings.
• Evaluate simplified issues simultaneously with traditional applications, as health questions about valve disease vary dramatically between carriers. Some simplified products specifically exclude any valve disorde,r while others focus on symptoms and treatments, creating opportunities for stable mild-moderate AI cases.

For comprehensive protection planning, exploring the full spectrum of available options ensures you’re accessing carriers with underwriting approaches suited to your specific valve disease profile and not limiting yourself to companies unlikely to provide optimal outcomes.

How Does the Application Process Work?

Understanding the life insurance application timeline and requirements for individuals with aortic insufficiency helps you navigate the process efficiently and avoid delays that can compromise outcomes or create frustration during an already complex situation.

Initial Application and Disclosure

The process begins with completing a detailed health questionnaire covering cardiac conditions, medications, surgeries, symptoms, and medical history. Accurate and complete disclosure is essential – omitting or minimizing valve disease can result in future claim denials regardless of intent.

When describing your condition, provide specific details rather than vague statements. Instead of “heart murmur,” state “mild aortic insufficiency (Grade 1) with normal left ventricular dimensions and ejection fraction of 62%, asymptomatic, no treatment required, followed yearly by cardiology.” Specific favorable details help underwriters make an accurate initial assessment and may expedite processing.

Medical Records Review

After application submission, the insurance company requests medical records from your physicians. This process typically requires 2-4 weeks, depending on healthcare provider responsiveness and record completeness.

You can dramatically accelerate the process by proactively obtaining your cardiology records and providing them with your application. Key documents include recent echocardiogram reports, cardiology consultation notes, surgical records if applicable, and any cardiac catheterization or advanced imaging reports. Complete documentation eliminates delays and ensures underwriters have all favorable information from the outset.

Medical Examination Requirements

Traditional fully underwritten policies require paramedical examinations, including vital signs, blood work, urinalysis, and typically an EKG. The examination occurs at your location at no cost, usually within one week of application.

For individuals with AI, the examination may reveal a heart murmur on auscultation or abnormal findings on EKG. These findings don’t negatively impact your application when medical records document the known valve disease – in fact, consistency between examination and documented history supports application credibility. The examination provides a current snapshot, but doesn’t replace a comprehensive echocardiographic assessment already in your records.

Underwriting Decision Timeline

Straightforward AI cases with complete documentation typically receive decisions within 3-5 weeks of completed application and examination. Complex situations requiring medical director review, clarification of valve surgery details, or assessment of borderline severity may extend to 6-10 weeks.

If underwriters request additional information – such as updated echocardiogram, detailed cardiology letter explaining prognosis, or surgical follow-up notes – respond promptly. Many delays result not from underwriter indecision but from waiting for applicant or physician responses to clarification requests.

Navigating Unfavorable Decisions

If you receive a rating higher than expected or a decline, several options exist before accepting the decision as final:

• Request a detailed explanation of the underwriting rationale, including specific factors that led to the classification. Understanding whether the decline resulted from LV dilation, regurgitation severity, or other factors helps you determine if additional documentation might change the outcome or if alternative carriers would be more appropriate.
• Consider informal appeals with additional documentation when you believe the decision doesn’t reflect the current status. Updated echocardiograms showing stability or improvement, detailed cardiology letters explaining favorable compensation, or post-surgical follow-up confirming excellent outcome, sometimes result in improved classifications upon reconsideration.
• Explore alternative carriers with different underwriting approaches rather than accepting unfavorable terms from the initial company. Decline or heavy rating from one carrier doesn’t predict outcomes elsewhere, particularly for borderline moderate AI cases where underwriting philosophy variations significantly impact decisions.
• Investigate simplified issue or guaranteed issue options if traditional underwriting consistently produces prohibitive ratings or declines. These products provide certain approval with different cost structures that may better suit your situation than pursuing traditional coverage, which is unlikely to be approved at reasonable rates.

For personalized guidance navigating aortic insufficiency-related life insurance applications, contact Insurance Brokers USA at 888-211-6171 to discuss your specific valve disease profile with specialists experienced in cardiac underwriting and strategic carrier placement for valvular disorders.

Frequently Asked Questions