Find Out If You Qualify for Long-Term Care Insurance

Confidential pre-screen — not an application

Complete this confidential pre-screen so our licensed specialists can identify which long-term care insurance options you’re most likely to qualify for. We’ll use your answers to match you with the most appropriate carriers and plan designs.

Before You Start

To save you time, please review the Disqualifying Health Conditions below. A “Yes” answer means you will not qualify for long-term care insurance at this time. If you’re not sure how to answer, please contact our office and we can help you clarify your eligibility.

Disqualifying Health Conditions (review before you continue)
  1. Are you currently receiving home health care services or residing in a rehabilitation center, nursing home, or assisted living facility?
  2. Do you currently need help or supervision with daily activities such as bathing, dressing, eating, toileting, or transferring in and out of bed, or do you have bowel or bladder incontinence?
  3. Have you been diagnosed with, or are you being treated for, Alzheimer’s disease, dementia, Parkinson’s disease, or another cognitive impairment?

LTC Insurance Prequalification Form