Independent Health Insurance Broker

Long-term care

Tell us who needs coverage and how to reach you. With your permission, we share this with a trusted specialist and follow up within 24 hours.

Request a long-term care conversation

This form is only for long-term care. If you also need Medicare or an individual health plan, say so and we will help with that directly.

Your contact info

First name

Last name

Phone

Best time to reach you

Preferred way to reach you

Who needs coverage

Couples are often quoted together. Most traditional policies are issued from about age 40 to 79. If you are outside that range, send the form anyway.

Who should the quote include?

Your date of birth

What prompted this request?

One health question

Yes or no is enough. Please do not share medical details.

Do any of these apply to you, or to your spouse or partner if they are included?

Currently receiving care
Help with daily activities
Use a walker or wheelchair
Memory loss or dementia
Parkinson’s or MS
A recent stroke

NoNone of these applyYesOne or more apply

A general sense of finances

Ranges are enough. Savings means investments and cash, not your home. A very limited amount is sometimes a better fit for Medicaid planning than for a policy.

Approximate savings and investments

Monthly amount that would feel comfortable

Do you already have long-term care coverage?

Do you also want help with health insurance?

Where you need coverage

State

County

ZIP code

Anything else the specialist should know? Optional.

I authorize Nye Insurance to share my information with a trusted long-term care specialist.

We need this permission to make the introduction. Your text-message opt-in is not included in what we share.

Text message consent

By selecting Yes, you consent to receive recurring customer care SMS text messages from Nye Insurance LLC at the mobile number you provide, sent from (503) 966-2345, about your insurance inquiry, enrollment questions, and related customer care. Message frequency varies. Message and data rates may apply. Reply STOP to unsubscribe at any time. Reply HELP for help. Consent is not a condition of purchase. We do not share mobile opt-in information with third parties. See our Privacy Policy and Messaging Terms (https://lorinye.com/privacy).

Yes, I agree to receive customer care text messages from Nye Insurance about my insurance inquiry and coverage.No, I do not want to receive text messages from Nye Insurance.

You’ll get a confirmation email. With your permission, a specialist will follow up within 24 hours.

Messaging terms

Program description: customer care texting only (appointment follow-up, answers to coverage questions, and other messages related to your relationship with Nye Insurance). This is not a marketing or promotional SMS program. You can cancel anytime by texting STOP; after you text STOP we will confirm you are unsubscribed. For assistance, text HELP or email support@lorinye.com.

Contact Information

Service Area

Licensed in Oregon and Washington. Serving clients throughout both states.

Office Hours

Monday – Friday8 AM – 6 PM PST

Saturday9 AM – 2 PM PST

SundayClosed

Nye Insurance