Long Term Care Form - Compare quotes online

Plan for future care

Long-Term Care Insurance Quote

Start with a few details about the person to be insured and your planning goals. An agent will help you review available options.

You do not need to choose every benefit now. This is an initial request; carrier applications and medical underwriting come later through the appropriate process.

1. Planning needs2. Preferences & contact

Planning needs

Who would you like coverage for? (required)

State of residence of the person to be insured (required)

For a couple, start with your state. Only our licensed states are listed.

Residential ZIP code of the person to be insured (required)

Age of the person to be insured (required)

For a couple, enter your age here. No date of birth is needed for this initial request.

Does this person currently use tobacco or nicotine? (required)

Spouse / partner age (optional)

Spouse / partner state of residence (optional)

Choose a state if different; an agent will confirm both residences.

Spouse / partner tobacco or nicotine use (optional)

What brings you here? (required)

New insurance may not be available for an existing care need. An agent can discuss coverage questions; this form does not arrange care services. Please do not enter medical details.

Does the person to be insured already have long-term care coverage? (required)

Include a traditional policy or long-term care benefits linked to life insurance or an annuity. For a couple, choose Yes if either person has coverage.

Preferences & contact

Which options would you like to discuss? (required)

Availability and eligibility vary. You are requesting a review, not selecting or purchasing a policy.

Benefit preferences and budget (optional)

Skip anything you are unsure about. These are starting preferences, not guaranteed benefits or available policy options. An agent will explain the trade-offs and confirm terms.

Target monthly care benefit (USD) (optional)

Per person. Leave blank if you would like help estimating care costs.

Preferred benefit period (years) (optional)

For example, 3 years. The actual duration or benefit pool depends on the policy.

Preferred waiting period (days) (optional)

The elimination period applies after qualifying for benefits. How days are counted varies by policy.

Inflation protection to discuss (optional)

Inflation options can increase benefits over time; terms and cost vary.

Home care benefit preference (optional)

Some policies express home care benefits as a percentage of the facility benefit. An agent will explain the actual policy design.

Comfortable monthly premium budget (USD) (optional)

Per person, for recurring premiums. Leave blank to discuss budget or lump-sum funding options.

Insurance companies you would like reviewed (optional)

We will confirm availability and whether we can offer the requested company.

Current long-term care insurance company (optional)

Name only; please do not enter a policy number.

Additional features to discuss (optional)

Shared CareWaiver of Elimination Period for Home CareSurvivorshipJoint Waiver of PremiumNonforfeiture

Not sure what these mean? Leave them blank and an agent can explain relevant options. Features vary by policy and may not be available together.

Your full name (required)

Enter the name of the person we should contact.

Your relationship to the person to be insured (optional)

For example, adult child or authorized representative. Do not enter their medical information.

Preferred contact method (required)

Your email address (optional)

Your phone number (optional)

Include your area code.

General questions or planning notes (optional)

Do not include diagnoses, medications, medical history, Social Security numbers, dates of birth, policy numbers, or financial account details.

This request does not start, bind or change coverage. Eligibility, premiums and benefits depend on the insurer, state, policy design and underwriting. An agent may need additional information before providing an individualized quote.

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