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Attorney Access is designed exclusively for elder law attorneys. Creating a free account gives you instant access to exclusive Medicaid planning resources and materials, such as:

State-Specific planning figures;
Library of KrauseCAST webinars;
National attorney message board, and more!

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Attorney Access

Why Krause
- About Us
- Our Team
- History
- FAQs
- Careers
Resources
Products
Services
Education
Contact Us
Attorney Access

PRE-PLANNING TOOL

Long-Term Care Insurance

Contact Information
Name*
Email*
Phone
Relationship to Insured*
How would you like us to reach out?
- Please do not contact my client at this time and send all information to me.
- Please reach out to my client directly.
Client Email Address
Client Phone Number
Please explain*
Proposed Insured Information
The "first person" is the proposed policyholder. If they are married and are seeking a joint policy, please complete the applicable information in the "second person" column for their partner.
FIRST PERSON
SECOND PERSON
Name
Name
Birth Date OR Age*
Birth Date OR Age
Gender*
Gender
State of Residence*
Health
Health
Health Pre-Screen
FIRST PERSON
SECOND PERSON
Height
Height
Weight
Weight
Smoker?
Smoker?
Date of most recent doctor visit/reason for visit:
Date of most recent doctor visit/reason for visit:
Medications, dosage and reason for taking them and for how long? Any pain medications or treatments, shots? Date of last one?
Heart or Lung Issues? Bypass? COPD When?
Bone or Joint Issues? Osteoporosis or Osteopenia? Last Bone Density Test?
Joint Replacements? When?
Cancer of any kind? Stage? Metastasis? Date of last treatment
Diabetes? A1C Score? Insulin? How many units?
Arthritis - Rheumatoid? Osteo?
Any planned or suggested surgeries?
Sleep Apnea? Are you compliant with a device? For how long?
Vertigo? Last episode? How often?
Are you collecting disability insurance? Private or Social Security?
Do you have a handicapped license plate or sticker?
- Yes
- No
- Yes
- No
Have you been declined previously for LTCi?
- Yes
- No
- Yes
- No
Any other health issues we should know about?
Do you know the exact amount and what type of coverage you are looking for?
- Yes, I would like to specify the exact benefit coverage amounts (this is uncommon).
- No, please show me the best options available based on my financial situation.
Financial Information
This information will help us determine if a long-term care insurance policy is financially suitable and will help us design a policy customized for you.
Income Information

(Gross Monthly)
FIRST PERSON
SECOND PERSON
Monthly Employment Income
Monthly Employment Income
Monthly Social Security Income
If currently receiving benefits, please type the monthly amount received. If not taking benefits, please type the projected monthly benefit amount at normal retirement age.
Monthly Social Security Income
Monthly Pension(s) Income
Monthly Pension(s) Income
Other Monthly Income
Other Monthly Income
Total Monthly Income
Total Monthly Income
Asset Information
Retirement Accounts
Total combined value of IRAs, Roth IRAs, 401(k)s, SEPs, SIMPLEs, etc.
Retirement Accounts
Annuity Information
Current Value Capital Gain
Annuity Information
Current Value Capital Gain
Total Value of all annuities
Total Value of all annuities
Non-Qualified Assets
Total of checking, savings, taxable investments (i.e. stocks, bonds, mutual funds, CDs). DO NOT INCLUDE retirement accounts, personal property, vehicles, illiquid assets.
Non-Qualified Assets
Additional Notes
Benefit Coverage Amounts
Please fill out the following information only if you have a specific coverage amount you would like quoted. If you would like a policy designed based on the insured's financial information, please select "No" above.
FIRST PERSON
SECOND PERSON
Monthly Benefit ($)
Please enter a number from 2000 to 12000.
Monthly Benefit ($)
Please enter a number from 2000 to 12000.
Years of Coverage
Years of Coverage
Inflation Protection
Inflation Protection
NOTE: State partnership only available for traditional policies
Type of Policy
Type of Policy
Additional Notes
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Note: You may select up to three states in which you conduct business. If you need access to additional states, please contact us directly for assistance.

How did you hear about us?
Tell us how you heard about us:*
Have you worked with us on a Medicaid or VA planning case in the past?*
Approximately when was the last time you worked with us?*
What is your level of experience in Medicaid planning?
What is your primary reason for joining Attorney Access? (select all that apply)*
- State-specific Medicaid resources
- To watch KrauseCAST Webinars
- To watch educational videos
- To access a custom planning dashboard
- To engage on the attorney message board
- To access exclusive content
- To learn how to grow my practice
- To learn how to better help my clients

ACKNOWLEDGMENTS
Attorney Access is solely intended for use by elder law attorneys, their staff, and other elder care professionals. If you are an individual seeking Medicaid or VA information for yourself or a loved one, please contact our office directly, and we’ll be happy to provide a recommendation for an elder law attorney in your area.
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Attorneys

Leading the industry for more than 25 years, Krause Financial Services supports elder law attorneys advising clients with emergency Medicaid Planning and long-term care planning. Education, resources, state-specific figures and more.

Financial Planners – Agents

The Krause Agency delivers unparalleled service and resources to insurance agents advising their clients through crisis Medicaid planning and long-term care planning. Education, resources, state-specific figures and more.

Individuals – Consumers

Are you seeking guidance and assistance for your own financial planning or helping a loved one with their financial planning? Krause partners with trusted Financial Planners and Attorneys nationwide to help people accelerate eligibility for Medicaid benefits and gain relief from the financial hardship of long-term care.

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