Get a Quote for Long Term Care Next Previous Reason to buy long Term Care Works well with Estate Planning Protect Family Inheritance/Assets Protect your Quality of Life Protect $1 for $1 on a Tax Qualified Plan Questions to ask about long term care How much do I need How long do I need it for How do I set the policy up What are the tax benefits Get in Touch With A-1 Insurance Group, Inc. Name* First Last Address* Apt number/unit City State Zip Code County* Phone Number*Email* Height*4ft5ft6ft7ft8ft9ft10ftInches123456789101112Weight Date of Birth* MM slash DD slash YYYY Use Tobacco*YesNoHealth conditionsDo you take a medication?NoYesMedication Name* Quantity* Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 1* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 2* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 3* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 4* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 5* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 6* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 7* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 8* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 9* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 10* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 11* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 12* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 13* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 14* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 15* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 16* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 17* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 18* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 19* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 20* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 21* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 22* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 23* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 24* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 25* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 26* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 27* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 28* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 29* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 30* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 31* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 32* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 33* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 34* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 35* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 36* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 37* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 38* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 39* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* Add another medication*NoYesMedication Name 40* Quantity*Per*DayWeeksMonthsThree MonthsType*PillsCannisterTubesBottlesVialsPatchesDosage Type*MGMCGUnits Per Day%SOLUTIONDosage Amount* HiddenHow long do you need the policy to last?*1 year2 years3 years4 years5 years6 years7 years8 years9 years10 yearslifetimeMonthly Benefits Requested*$1000$2000$3000$4000$5000$6000$7000$8000$9000$10000$11000$12000$13000$14000$15000Elimination Period*0 days30 days60 days90 days180 days365 daysInflation Protector*YesNoDoes it need to be partnership qualified?*YesNoCommentsThis field is for validation purposes and should be left unchanged.