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Please provide the following information
Providing a list of your prescriptions drugs and estimated costs is not required and will not affect eligibility for any Medicare Part D Prescription Drug Plan you select. Any information you provide will only be used to help guide you toward appropriate Medicare Part D Prescription Drug Plan(s) for your unique needs. You cannot be declined coverage. Everyone with Medicare, regardless of income, health status, or prescription drug usage, has access to Medicare Part D prescription drug coverage.

Please provide the following information
How much the policy pays out per day for nursing care or home health care is the Daily Benefit.
The length of time for which a policy will continue to pay the benefits associated with
long-term care is the Benefit Period.
With most policies, your benefits won't start the first day you go to a nursing home or start using home care. During an Elimination Period, the policy will not pay the cost of long-term care services.
There is an option with most plans called an Auto Inflation Rider, available at an additional cost, which increases the benefits according to the rises in inflation. For Texas consumers, compound protection must be rejected before other forms are considered.
No
Yes
Nonforfeiture benefits in policies, available at an additional cost, provide that at least some benefits will be paid even if the buyer fails to keep up premium payments and the policy is cancelled for non-payment.
Annual
Semi-Annual
Quarterly
Monthly
The Payment Mode indicats whether you want to pay for the insurance once a year (annually), semi-annually, quarterly or monthly. When not paying annually there is usually an additional administration fee.
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If you are younger than 64 1/2 and you are on Medicare due to a disability please click here to receive information about our Medicare Advantage Plans.
Male
Female
Yes
No
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 in
 lbs
Non-Smoker
Smoker
No
Yes (Within Last 5 Years)
Yes
No
Yes
No

 

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