How Heart Disease Affects Life Insurance Pricing
Life insurance carriers price cardiac risk using a system that accounts for three variables: what happened, how long ago it happened, and how well you have recovered. Understanding this system helps you predict your costs and recognize when a carrier is overcharging you.
The pricing mechanism is the table rating system — the same system used for DUI, diabetes, and other substandard risks. Each table adds 25% to the Standard premium:
| Table Rating | Premium vs. Standard |
|---|---|
| Table 1 (A) | 125% |
| Table 2 (B) | 150% |
| Table 3 (C) | 175% |
| Table 4 (D) | 200% |
| Table 5 (E) | 225% |
| Table 6 (F) | 250% |
| Table 7 (G) | 275% |
| Table 8 (H) | 300% |
A 50-year-old male paying $90/month at Standard for $500,000 of 20-year term would pay $180/month at Table 4. That is $1,080/year in extra premium — or $21,600 over the life of the policy. The difference between Table 2 and Table 4 alone is $540/year, which is why choosing the right carrier matters so much.
Table Ratings for Cardiac Conditions
The following table shows the typical range of table ratings by condition type and time since event. Ratings assume stable follow-up, medication compliance, and no concurrent smoking.
At 12-24 Months Post-Event
| Condition | Best Case Rating | Typical Rating | Worst Case Rating |
|---|---|---|---|
| Benign murmur | Standard | Standard | Standard |
| AFib (lone, controlled) | Standard | Table 1 | Table 2 |
| AFib (with structural disease) | Table 1 | Table 2-3 | Table 4 |
| Single stent (elective) | Table 1 | Table 2 | Table 3 |
| Single stent (post-MI) | Table 2 | Table 3 | Table 4 |
| Multiple stents | Table 2 | Table 3-4 | Table 5 |
| Heart attack (mild, single vessel) | Table 2 | Table 3 | Table 4 |
| Heart attack (moderate) | Table 3 | Table 4-5 | Table 6 |
| Heart attack (severe, multi-vessel) | Table 4 | Table 5-6 | Table 8 |
| Bypass (2-3 vessels) | Table 3 | Table 4-5 | Table 6 |
| Bypass (4+ vessels) | Table 4 | Table 5-6 | Table 8 |
| Valve replacement (tissue) | Table 3 | Table 4 | Table 6 |
| Valve replacement (mechanical) | Table 4 | Table 5-6 | Table 8 |
| CHF (EF > 40%) | Table 4 | Table 6-7 | Table 8 |
| CHF (EF 30-40%) | Table 6 | Table 8 | Decline |
Best case assumes: excellent follow-up test results, all risk factors controlled, favorable carrier, experienced broker. Worst case assumes: borderline test results, some uncontrolled risk factors, unfavorable carrier.
At 3-5 Years Post-Event
| Condition | Best Case Rating | Typical Rating |
|---|---|---|
| AFib (controlled) | Standard | Standard-Table 1 |
| Single stent | Standard | Table 1-2 |
| Multiple stents | Table 1 | Table 2-3 |
| Heart attack (mild) | Table 1 | Table 2 |
| Heart attack (moderate) | Table 2 | Table 3-4 |
| Bypass (2-3 vessels) | Table 2 | Table 3-4 |
| CHF (stable, EF > 40%) | Table 3 | Table 4-6 |
At 5+ Years Post-Event
| Condition | Best Case Rating | Typical Rating |
|---|---|---|
| AFib (controlled) | Preferred | Standard |
| Single stent | Standard | Standard-Table 1 |
| Heart attack (mild) | Standard | Table 1-2 |
| Bypass surgery | Table 1 | Table 2-3 |
| CHF (stable) | Table 2 | Table 4-5 |
Rate Tables by Condition and Age
All rates below are monthly premiums for $500,000, 20-year term, male, non-smoker, at 2-3 years post-event with stable follow-up. Female rates are approximately 15-25% lower.
Atrial Fibrillation (Controlled)
| Age | Standard (No Heart Issues) | AFib — Best Carrier | AFib — Average Carrier |
|---|---|---|---|
| 40 | $32-38 | $32-42 | $40-52 |
| 45 | $48-58 | $48-64 | $60-80 |
| 50 | $78-92 | $82-110 | $98-128 |
| 55 | $125-148 | $132-175 | $156-205 |
| 60 | $210-250 | $225-300 | $262-348 |
Best carrier = John Hancock or Prudential (may offer Standard). Average carrier = typical Table 1-2 rating.
Post-Stent (Single Stent, Stable Recovery)
| Age | Standard (No Heart Issues) | Post-Stent — Best Carrier | Post-Stent — Average Carrier |
|---|---|---|---|
| 40 | $32-38 | $48-57 | $58-72 |
| 45 | $48-58 | $72-87 | $86-110 |
| 50 | $78-92 | $117-138 | $140-175 |
| 55 | $125-148 | $188-222 | $225-280 |
| 60 | $210-250 | $315-375 | $378-475 |
| 65 | $350-420 | $525-630 | $630-798 |
Best carrier = Lincoln Financial (Table 2). Average carrier = Table 3.
Post-Heart Attack (Moderate, Single Event)
These figures assume you’re past the postponement window; for the full timeline of when you can apply and how rates fall at the 1-, 2-, and 5-year marks, see life insurance after a heart attack.
| Age | Standard (No Heart Issues) | Post-MI — Best Carrier | Post-MI — Average Carrier |
|---|---|---|---|
| 45 | $48-58 | $96-130 | $120-155 |
| 50 | $78-92 | $156-207 | $195-248 |
| 55 | $125-148 | $250-332 | $312-398 |
| 60 | $210-250 | $420-562 | $525-672 |
| 65 | $350-420 | $700-945 | $875-1,130 |
Best carrier = Prudential (Table 3). Average carrier = Table 4-5.
Post-Bypass Surgery (3 Vessels)
| Age | Standard (No Heart Issues) | Post-CABG — Best Carrier | Post-CABG — Average Carrier |
|---|---|---|---|
| 50 | $78-92 | $195-230 | $234-276 |
| 55 | $125-148 | $312-370 | $375-444 |
| 60 | $210-250 | $525-625 | $630-750 |
| 65 | $350-420 | $875-1,050 | $1,050-1,260 |
Best carrier = Prudential or Banner Life (Table 4). Average carrier = Table 5-6.
Congestive Heart Failure (Mild, EF > 40%)
| Age | Standard (No Heart Issues) | CHF — Best Carrier | CHF — Average Carrier |
|---|---|---|---|
| 50 | $78-92 | $234-276 | $312-368 |
| 55 | $125-148 | $375-444 | $500-592 |
| 60 | $210-250 | $630-750 | $840-1,000 |
| 65 | $350-420 | $1,050-1,260 | Decline |
Best carrier = Prudential or Transamerica (Table 5-6). Average carrier = Table 7-8 or decline.
How Ejection Fraction Affects Your Rate
Ejection fraction (EF) — the percentage of blood pumped out of the heart with each beat — is the single most important number in cardiac underwriting. It tells the underwriter how well your heart is functioning, regardless of what caused the damage.
Normal EF is 55-70%. Here is how carriers interpret different ranges:
| Ejection Fraction | Underwriting Impact | Typical Rating Adjustment |
|---|---|---|
| 55-70% (normal) | No impact from EF | Condition-specific rating only |
| 50-55% (low normal) | Minimal concern | No additional rating |
| 45-50% (mildly reduced) | Some concern | Add 1 table to condition rating |
| 40-45% (moderately reduced) | Significant concern | Add 1-2 tables; some carriers decline |
| 35-40% (reduced) | Major concern | Add 2-3 tables; many carriers decline |
| 30-35% (severely reduced) | Very difficult | Most carriers decline; GI only at some |
| Below 30% | Traditional UW nearly impossible | Guaranteed issue or group coverage |
The EF example: Two 55-year-old males both had a heart attack two years ago. Patient A recovered with an EF of 58%. Patient B recovered with an EF of 42%.
- Patient A: Table 3 at Prudential — $312/month for $500K
- Patient B: Table 6 at Prudential — $500/month for $500K (if approved)
- Difference: $188/month, or $45,120 over 20 years
This is why getting your EF as high as possible through cardiac rehabilitation, medication compliance, and lifestyle changes is not just good for your health — it is good for your wallet.
Important: Carriers want the most recent EF measurement. If your EF improved from 38% immediately post-event to 52% at your 12-month follow-up, the 52% is what matters. Make sure your records clearly show the improvement trajectory.
Number of Vessels and Your Premium
For heart attacks and bypass surgery, the number of coronary vessels affected is a key underwriting factor. More vessels involved means more extensive disease, which means higher ratings.
Heart attack (myocardial infarction):
| Vessels Involved | Typical Table Rating | Monthly Premium ($500K, Male, Age 55) |
|---|---|---|
| Single vessel, mild MI | Table 2-3 | $188-260 |
| Single vessel, moderate MI | Table 3-4 | $250-332 |
| Two vessels | Table 4-5 | $312-408 |
| Three vessels (triple vessel disease) | Table 5-7 | $375-520 |
| Left main disease | Table 6-8 or decline | $500+ or decline |
Left main coronary artery disease is the most serious because the left main supplies the majority of blood to the heart. Many carriers decline left main disease within 5 years of diagnosis.
Bypass surgery (CABG):
| Number of Grafts | Typical Table Rating | Monthly Premium ($500K, Male, Age 55) |
|---|---|---|
| 2 grafts (double bypass) | Table 3-4 | $250-332 |
| 3 grafts (triple bypass) | Table 4-5 | $312-408 |
| 4 grafts (quadruple bypass) | Table 5-6 | $375-480 |
| 5+ grafts | Table 6-8 | $500-592 |
The nuance: Not all vessels are equal. A blockage in the LAD (left anterior descending artery, sometimes called “the widow maker”) is taken more seriously than a blockage in a smaller branch vessel. A good broker will present your case highlighting which specific vessels were involved and their relative significance.
How Rates Improve Over Time
The trajectory of rate improvement varies by condition, but the general pattern is consistent: the biggest improvements happen in years 1-3 post-event, with continued but smaller improvements through year 5 and beyond.
Rate trajectory: 50-year-old male, $500K, 20-year term, post-heart attack (single vessel, moderate)
| Time Since Event | Typical Rating | Monthly Premium | Savings vs. Year 1 |
|---|---|---|---|
| 6 months | Decline or Table 6-8 | $468-552+ | — |
| 12 months | Table 4-5 | $312-378 | $156-174/mo |
| 18 months | Table 3-4 | $260-332 | $208-220/mo |
| 24 months | Table 3 | $234-276 | $234-276/mo |
| 36 months | Table 2-3 | $195-260 | $273-292/mo |
| 5 years | Table 1-2 | $156-195 | $312-357/mo |
| 7 years | Standard-Table 1 | $98-135 | $370-417/mo |
| 10 years | Standard | $90-105 | $378-447/mo |
What this means in practical terms: If you applied at 12 months and got a $500K policy at $340/month, and you re-apply at 5 years and get the same coverage at $175/month, you save $165/month — $1,980/year — for the remaining 15 years of the policy. That is $29,700 in savings.
The re-shopping strategy: Apply for coverage as soon as you are eligible (typically 12-24 months post-event). Then re-shop your coverage at the 3-year mark and again at the 5-year mark. Each time, you should qualify for a lower table rating. Never cancel your existing policy until the new one is in force — this is critical because there is always a risk that the new application is declined.
Other Factors That Affect Cardiac Rates
Your cardiac condition is the primary driver of your rate, but several other factors interact with it:
Smoking status:
- Non-smoker cardiac rates are as shown above
- Smoker cardiac rates are approximately 2.5-3x the non-smoker rates
- Quitting smoking after a cardiac event is the single largest rate improvement available
- Most carriers require 12 months tobacco-free to classify as non-smoker
Diabetes:
- Diabetes combined with heart disease typically adds 1-2 additional table ratings
- A heart attack patient with well-controlled Type 2 diabetes might be Table 5-6 instead of Table 3-4
- A1C level matters — under 7.0 is viewed favorably
Obesity:
- BMI over 30 adds 1 table to most cardiac ratings
- BMI over 35 adds 2 tables
- BMI over 40 may result in decline when combined with cardiac history
- Weight loss after a cardiac event is viewed very positively by underwriters
Family cardiac history:
- A parent or sibling with heart disease before age 60 adds modest extra risk
- This factor is secondary to your own condition and test results
- It matters more for conditions like AFib where genetics play a larger role
Medication list:
- Standard cardiac medications (statins, aspirin, beta-blockers, ACE inhibitors) are expected and do not add to your rating
- Blood thinners (warfarin, eliquis) suggest a more serious condition and may add 1 table
- Multiple heart medications suggest complexity and may add 1-2 tables
- Medication compliance is key — gaps in prescriptions are a red flag
Exercise capacity:
- If you can complete a cardiac stress test to Stage 3 or beyond (Bruce protocol), this is strongly favorable
- Many carriers will reduce a table rating by 1 level for excellent exercise capacity
- Cardiac rehab completion is viewed positively
Bottom line: Your rate with heart disease is not fixed — it is a function of your specific condition, how well you manage it, and which carrier you choose. A difference of 2 table ratings on a $500K policy can mean $40,000+ over the life of the policy. It is worth investing time to find the right carrier and optimize your health metrics. See our guide to the best carriers for heart disease to identify the right company for your situation.
Frequently Asked Questions
How much more does life insurance cost after a heart attack?
At 12-24 months post-heart attack, expect to pay 75-150% more than standard rates. For a 50-year-old male seeking $500,000 in 20-year term coverage, that means roughly $145-210 per month compared to $82-95 for a healthy applicant. Rates improve over time — at 5+ years post-event with stable follow-up, the surcharge may drop to 25-50%.
Does atrial fibrillation affect life insurance rates?
Controlled AFib has a relatively modest impact on rates. Depending on the carrier, well-managed AFib with no stroke history may result in Standard rates or a Table 1-2 rating (0-50% surcharge). John Hancock and Prudential are the most favorable carriers for AFib. Uncontrolled AFib or AFib with stroke history carries significantly higher ratings.
Are life insurance rates different for stents vs. bypass surgery?
Yes. Stent patients generally receive more favorable ratings than bypass patients. A single stent placed 2 years ago might be rated Table 2 (50% surcharge), while bypass surgery 2 years ago might be Table 4-5 (100-125% surcharge). The difference reflects the greater severity typically associated with conditions requiring bypass.
What ejection fraction do I need for life insurance approval?
Most carriers want an ejection fraction (EF) of 45% or above for traditional underwriting. EF above 50% is considered normal and results in the most favorable ratings. EF of 40-45% is borderline — some carriers will approve, others will decline. Below 40% makes traditional coverage very difficult, and below 30% generally limits you to guaranteed issue products.
Will my life insurance rates go down over time after a cardiac event?
Your existing policy rate will not change — premiums are locked at issue. However, you can apply for a new policy at better rates as time passes. Most carriers improve your rating class at the 2, 3, and 5-year marks post-event, assuming stable follow-up and no new cardiac issues. Re-shopping your coverage at the 3 or 5-year mark can save significant money.
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