About LTC Insurance Alzheimer's & Cost Benefit Triggers Choosing Assisted Living Facilities Choosing the Right Insurer Cost Factor Covered Services FAQ's Free Quote Glossary Group LTC Ins Plans Inflation Protection Insurance Shopping Tips Long Term Care Policy Rates LTC and Your Retirement Plans LTC Cost in 50 States LTC Policy Inclusions LTC Press Release LTC Resources LTC & Tax Deductions Medicaid Eligibility Money Saving Tips Myths and Facts Optional Benefits Sample Quotes Talk to Us Testimonials Usefull Resources What is LTC Insurance Why Buy LTC Insurance

Get your Long Term Care Insurance quote online!
Our service is free and your privacy is protected!

IMPORTANT: LTC Planners does not require your Social Security number, nor do we ask for a credit card number. You are under no obligation to purchase a policy, and there are No quote fees.

To obtain a FREE long term care quote, please complete the following insurance request form and click "SUBMIT" below.

Your Long Term Care Insurance quote request takes only a couple minutes to complete and we'll provide you with insurance options that are customized to meet your specific requirements.

Your long term care request will be handled in in the strictest confidence. LTC Planners will not share your personal information with spammers or other advertisers. We believe in protecting your right to privacy and will only send Long Term Care Insurance Industry News if you select the "Yes" option to receive whole life updates.

---

Long Term Care Insurance Quote Request
First name:
Middle Initial:
Last name:
Address Line 1:
Address Line 2:
City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN UT VT VA WA WV WI WY
Zip:
Home Telephone:
How did you hear about our service?	Google MSN Other search engine Word of Mouth Other
Are you still employed?	Yes No
If yes, do you own your own company?	Yes No
Work phone:
Fax:
Email:
Would you like to receive occasional updates on whole life insurance coverage via e-mail from our company?	Yes No
Birth date (MM/DD/YYYY):
Gender:	Male Female
How would you classify your health?	Excellent Good Fair Poor
Do you have any serious health problems?	Yes No
Marital Status:	Single Married applying with spouse Married applying without spouse
Note: If you’re married but want a long term care insurance quote on just yourself, please answer the previous question "Single."
Spouse's name:
Spouse's Birth date:
Does your spouse have any serious health problems?	Yes No
Do you currently own LTC Insurance?	Yes No
If so, with which company?
Comments or special requests: