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The Facts About Long Lerm Care Insurance: What Everyone Over 50 Should Know: You are taking an important step towards securing the financial future for you and your family. Your greatest financial risk today and in the foreseeable future is not your hospital or doctor bills, but the very high cost of long term care.

Over 40% of all Americans over the age of 65 will spend some time in a nursing home due to a prolonged illness or disability. That's almost one out of two. Your risk of needing long term care is probably much greater than you realize.

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What would happen to your family if you were to need nursing home care?  With Long Term Care insurance you (or your parents) won't have to worry about paying for extended care. Get a FREE no obligation Long Term Care Insurance Quote! You could save substantially for two minutes of your time

The short form below should be filled out as completely as possible in order to receive an accurate quote.

First Name

Last Name

 

Street Address

City

 

State

Zip Code

Day Phone

 

Evening Phone

 

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  19

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Weight

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Are you insulin-dependent?

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Do you use:

  cane
  walker
  wheel chair

If you use other medical
equipment, please describe
(otherwise, leave blank)

 

If you've required assistance with your everyday activities in the past 2 years please explain.
(otherwise, leave blank)

 

In the past 5 years, have you:

  been confined to a hospital/nursing home
  had home care
  had long term care
  recieved rehabilitation

If you have any particular health problems, please describe
(otherwise, leave blank)

 

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