Life insurance with MDS (myelodysplastic syndromes)
MDS is a group of blood cancers where the bone marrow does not produce enough healthy blood cells. We are upfront about this: life insurance with MDS is one of the more difficult areas of underwriting. Most mainstream insurers will decline. But options do exist, and understanding exactly what they are saves you time and unnecessary application rejections.
The short answer
Standard life insurance with active MDS is very difficult to obtain. Most mainstream insurers will decline. Your IPSS-R risk score is the most important factor: low-risk MDS on watch and wait has more options than high-risk MDS requiring chemotherapy or a stem cell transplant. Options include guaranteed acceptance policies, over 50s plans, group life through your employer, and in some cases specialist underwriters. Post-transplant with sustained remission (typically 3-5 years) may open limited doors with specialist insurers.
What insurers ask about MDS
If you apply for life insurance with MDS, insurers will ask detailed questions about your diagnosis and treatment. Most will request a medical report from your haematologist.
What is your specific MDS subtype?
MDS covers several subtypes including MDS with single lineage dysplasia, MDS with ring sideroblasts, MDS with excess blasts, and MDS with isolated del(5q). Each carries a different prognosis and is viewed differently by underwriters.
What is your IPSS-R risk score?
The Revised International Prognostic Scoring System (IPSS-R) is the key classification. It ranges from very low risk to very high risk. This single score tells an underwriter more about your prognosis than almost any other factor. If you do not know your IPSS-R score, ask your haematologist.
What treatment are you receiving?
Watch and wait (monitoring only) is viewed differently from active treatment. Erythropoietin or blood transfusions suggest more advanced disease. Azacitidine, lenalidomide, or intensive chemotherapy indicate higher-risk disease. Stem cell transplant is the most intensive intervention.
Have you had a stem cell or bone marrow transplant?
A transplant indicates high-risk disease, but successful engraftment with sustained remission may eventually open limited insurance options with specialist underwriters, typically after 3-5 years of disease-free survival.
What are your current blood counts and transfusion needs?
Stable blood counts without transfusion dependence are a positive indicator. Transfusion dependence (regular red cell or platelet transfusions) indicates more advanced disease and significantly narrows options.
Know your IPSS-R score before calling
Your haematologist can provide this. It is the single most important number for understanding your insurance options with MDS.
Get QuoteHow your IPSS-R risk category affects cover
The IPSS-R score stratifies MDS into risk categories that directly affect what insurance, if any, is available through standard underwriting channels.
Very low / low risk MDS
Limited specialist options
Watch and wait management with stable blood counts. This is the most favourable MDS scenario for insurance. Some specialist underwriters may consider applications, typically with significant loadings. Guaranteed acceptance and over 50s plans are available without medical questions. A small number of specialist brokers have access to underwriters who will consider low-risk MDS on a case-by-case basis.
Intermediate risk MDS
Very limited options
May be on treatment such as erythropoietin, lenalidomide, or azacitidine. Mainstream insurers will almost universally decline. Guaranteed acceptance products, over 50s plans, and group life schemes are the primary options. Some specialist underwriters may consider on a case-by-case basis if blood counts are stable.
High / very high risk MDS
Standard cover not available
On intensive chemotherapy, preparing for or recovering from a stem cell transplant, or transfusion dependent. Standard underwritten life insurance is not available. Guaranteed acceptance policies (no medical questions, typically up to 25,000 cover) and over 50s plans are the available options. Group life through an employer may also provide cover without individual underwriting.
Life insurance after a stem cell transplant for MDS
A stem cell transplant is the only curative treatment for MDS. Post-transplant, if you achieve sustained remission with normal blood counts and no graft-versus-host disease (GVHD), limited insurance options may become available over time.
Under 2 years post-transplant - too early for most underwriters. Guaranteed acceptance and group life are the options.
2-5 years post-transplant - a small number of specialist underwriters may consider applications if there is no evidence of relapse, normal blood counts, and no significant ongoing GVHD. Expect very significant loadings if terms are offered.
5+ years post-transplant - the best post-transplant window. Some specialist insurers will offer terms with significant but manageable loadings. Full disease-free survival with no complications is essential.
The honest answer
We will not pretend this is easy. MDS is a blood cancer, and most mainstream life insurers decline applications from people with active MDS. That is the reality. But it does not mean you have no options. Guaranteed acceptance products provide a baseline of cover without medical questions. Over 50s plans are available to those who qualify by age. Group life through your employer may already be covering you without individual underwriting. And for low-risk MDS or post-transplant patients in sustained remission, a small number of specialist underwriters will consider applications on their merits. What our partner brokers can do is tell you exactly which options apply to your specific situation, so you do not waste time and emotional energy on applications that will not succeed.
Options that are available with MDS
Even when standard underwritten cover is not available, there are meaningful alternatives worth understanding.
Guaranteed acceptance life insurance
No medical questions asked. Cover is typically capped at around 25,000 and there is usually a moratorium period (1-2 years) during which the full death benefit is not payable. After the moratorium period, the policy pays out in full regardless of cause of death. It is more expensive per pound of cover than standard insurance, but it guarantees you something.
Over 50s life insurance
Available to those aged 50-80 (age varies by insurer) with no medical questions. Similar to guaranteed acceptance, with a moratorium period and fixed monthly premiums. The cover amount is typically lower, but it can provide a meaningful sum for funeral costs, debts, or a legacy for family.
Group life insurance through your employer
Many employer group life schemes provide cover at a multiple of salary (often 2-4x) without individual medical underwriting. This is often the most valuable cover available to someone with MDS. Check with your HR department whether your employer offers death-in-service benefit. If you are changing jobs, this is a factor worth considering.
Specialist underwriters
A small number of specialist underwriting teams will consider MDS applications individually, particularly for low-risk MDS on watch and wait, or post-transplant patients in sustained remission. Access to these underwriters typically requires a specialist broker. Terms, if offered, will involve significant loadings, but the cover amounts can be meaningful.
Not sure which option applies to you?
Tell us your MDS subtype, risk score, and treatment status. Our specialist brokers will tell you exactly which options are realistic for your situation.
Get QuoteCritical illness and income protection with MDS
Critical illness cover is not available through standard underwriting with active MDS. Since MDS is itself a covered condition under most critical illness policies, insurers will not offer a policy to someone who already has the condition.
Income protection is similarly very difficult to obtain with MDS. The risk of being unable to work due to the condition or its treatment is too high for most insurers. Group income protection through your employer may be available, and it is worth checking whether your workplace provides this benefit.
If you were diagnosed with MDS after taking out critical illness cover, you may have a valid claim under your existing policy. Check your policy wording carefully - most critical illness policies cover bone marrow failure conditions including MDS.
Put your policy in trust
Whatever cover you obtain - whether a guaranteed acceptance policy or specialist underwritten cover - writing it in trust ensures the payout goes directly to your beneficiaries. This avoids the money being counted as part of your estate for inheritance tax purposes, and prevents probate delays at exactly the time your family needs the money most. It is free and takes minutes.
Read our full guide to trusts and estate planning
Frequently asked questions
Is MDS the same as leukaemia for insurance purposes?
MDS is classified as a blood cancer and is underwritten similarly to leukaemia by most insurers. Some MDS subtypes can progress to acute myeloid leukaemia (AML), which is one of the reasons insurers take it seriously. However, low-risk MDS with a very low chance of progression may be viewed slightly more favourably than AML itself.
I have low-risk MDS and am just being monitored. Can I get any cover?
Low-risk MDS on watch and wait has the best chance of obtaining some form of underwritten cover, though it remains difficult. Guaranteed acceptance products are available regardless. A specialist broker can approach underwriters who have considered low-risk MDS cases previously. Your stable blood counts and absence of treatment are positive factors.
My MDS was discovered incidentally through routine blood tests. Does that make a difference?
Incidental discovery can suggest earlier-stage disease, which is a positive indicator. However, it is the IPSS-R score and current disease status that drive underwriting decisions, not how the diagnosis was made. What matters is where you are now, not how you got there.
Should I wait until after my transplant to apply?
If you are awaiting or actively undergoing a stem cell transplant, waiting until you are in sustained remission post-transplant is generally advisable for underwritten cover. Applying during active treatment will result in a decline from standard insurers. However, guaranteed acceptance products can be taken out at any time, and there may be benefit in securing one before your transplant.
What is the moratorium period on guaranteed acceptance policies?
The moratorium period is typically 12-24 months from the start of the policy, during which the full death benefit is not payable if death results from a pre-existing condition. If death occurs during this period from a pre-existing condition, most policies return the premiums paid plus interest. After the moratorium period, the full benefit is payable regardless of cause of death.
Get honest guidance on insurance with MDS
Tell us your MDS subtype, IPSS-R score, and treatment status. Our specialist brokers will tell you exactly what is available and help you secure the best option for your situation.
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