A1C and Life Insurance Rates: What Underwriters Look At

Your A1C is one of the key numbers a life insurer is likely to ask about when you have diabetes, because it shows your average blood sugar over the past 3 months. Underwriters commonly use recent results, and the trend over time, to judge how well your diabetes is controlled. They weigh it alongside your treatment, any complications and your age at diagnosis, so no single A1C number guarantees a particular rate.

This guide explains what the A1C test measures, how doctors set goals, and how insurers generally factor it in. It describes common underwriting practice, not any one company's rules, and it isn't medical advice. For the full picture, see our guide to life insurance for diabetics.

What does an A1C test measure?

The A1C test measures how much sugar is attached to the hemoglobin in your red blood cells, which reflects your average blood sugar over about 3 months. The CDC explains that your red blood cells regenerate roughly every 3 months, which is why the test covers that period. It's also called the hemoglobin A1C, HbA1c or glycated hemoglobin test.

The result is a percentage. NIDDK lists these ranges for diagnosis:

The CDC also shows how A1C lines up with estimated average glucose, the unit your home meter uses:

NIDDK notes that this average won't match your daily readings, and that A1C doesn't show short-term highs and lows.

What A1C goal do doctors use?

The CDC says the A1C goal for most people with diabetes is 7% or less, but your doctor sets your specific goal based on your full medical history. NIDDK adds that a goal that is safe for one person may not be safe for another.

For example, NIDDK says a less strict goal, between 7% and 8% or sometimes higher, may be appropriate for people with long-standing diabetes who have trouble reaching a lower goal, severe low blood sugar, or advanced complications. Talk with your health care team about your target. Never change your treatment to get a better number for an insurance application without your doctor's guidance.

Why do life insurers care about your A1C?

Insurers care about A1C because it's a widely used measure of long-term blood sugar control, and control is linked to health risks. The CDC says higher A1C levels are linked to health complications. Over time, the CDC explains, high blood sugar can cause heart disease, vision loss and kidney disease.

Life insurance pricing is based on expected risk. The Texas Department of Insurance explains that cost depends on age, health and risk factors, and that a company can charge more for health conditions or refuse to sell a policy if it considers you a high risk. Your A1C is one of the clearest signals an underwriter has about how your diabetes is going.

How do underwriters weigh A1C with other factors?

Underwriters generally look at your A1C as part of a bigger picture rather than on its own. Here are the factors commonly reviewed together.

A steady A1C near your goal generally reflects well-managed diabetes, especially when there are no complications. A higher A1C, a rising trend or complications can lead to more questions, higher cost or a decline. How much weight each factor gets depends on the insurer.

Age at diagnosis matters because it shows how long you've lived with diabetes. Our guide to type 1 vs. type 2 diabetes and life insurance explains why.

Can one A1C result hurt your application?

A single result is usually read in context, not in isolation. NIDDK notes that when the test is repeated, a result can be slightly higher or lower. For example, it says an A1C reported as 6.8% could come back anywhere from 6.4% to 7.2% on a repeat test of the same blood sample.

Some health issues can also throw off the result. The CDC lists severe anemia, kidney failure, liver disease, certain blood disorders such as sickle cell anemia or thalassemia, some medicines, blood loss or transfusions, and early or late pregnancy. NIDDK adds that people of African, Mediterranean or Southeast Asian descent may carry a hemoglobin variant that affects some A1C tests.

If you have one of these issues, make sure your doctor has noted it in your records, and mention it to the insurer or agent.

How do insurers get your A1C results?

Insurers usually get your A1C from your application answers, your medical records or their own lab work, with your permission. When you apply for a fully underwritten policy, you typically authorize the insurer to review sources such as your doctors' records. Depending on your age and the coverage amount, the policy may also require a medical exam.

Insurers that belong to MIB also cross-check your application against your MIB file, and report information of underwriting significance back to it. You can request your own MIB file free once a year.

What if your A1C is higher than you'd like?

A higher A1C doesn't mean you can't get coverage, but it may narrow your options for now. Here are common routes:

• Compare insurers. Guidelines vary, so one company's decline isn't every company's decline.
• Look at simplified issue. Shorter health questionnaires may not ask for lab values. Our guide to guaranteed issue vs. simplified issue explains the difference.
• Use group coverage. The Texas Department of Insurance notes that group life through work usually doesn't require health questions for the basic amount.
• Consider guaranteed issue for smaller needs. No health questions, but small amounts and usually a limited benefit in the first years.
• Reapply later. If your results improve and stay steady, a new application may be reviewed differently.

Here's a hypothetical example. A 55-year-old with type 2 diabetes and a recent A1C above his doctor's target might keep group coverage from work in place now, work with his doctor on his care plan, and ask an agent to review his options again after several more steady results. He wouldn't drop existing coverage while he waits.

If you use insulin, see life insurance for diabetics on insulin. For more guides, visit the life insurance with diabetes hub.