"There is no better coverage available today."
R. Martin - MoneyWatch

Long Term Care Insurance Quote

To request a free quote:

Step 1 — Complete and submit the form below.

Step 2 — We will Email you a premium chart based on your age and your state of residence.

 

This form is to receive information and is not an insurance application. You do not have to be a member to receive a quote. We do not share or sell your information.

 

Name:

Age or Birth Date

Spouse or Other Name*:

Age or Birth Date

blankState of residence:
(required -premiums and applications are state specific)

Phone: (entry required)
*home, work, cell or repeat email
blankBest days to contact you:
M-Fblank blankSat blankSunblank
blankBest times to contact you: AM — blank PM

blankDoes either applicant take medications
blankor have health problems?
Selfblank blankSpouse/Otherblank
blankIf yes to above describe:
(Not everyone is insurable but do not assume that you are not.)

blankE-mail to send info: (required)

blank Application Preference:
blankOnline/Mailblank blankIn-Person

blank I currently have a LTC policy:
blankYesblank blankNo blank

blankAny comments:

blankWhen do you plan to insure?

blankHow did you find our website?


NOTES:

* Quotes are valid unless you have a birthday, a change of health.
* Second applicants can be spouses, siblings, friends, etc. of same generation that share living expenses to qualify for multi-life discount.


State laws require a signature for a medical records review. Underwriting application forms can be emailed or mailed but must be signed and returned. There is no obligation to see if you qualify.



Call toll free 1-888-582-2464
or email if you have any questions.