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The information that we indicate below as (Required) is the minimum necessary to generate quotes. Those fields that are designated as (Recommended) can be entered in order to provide you with more precise quotes when you are not in your Open Enrollment Period (OEP). We DO NOT require any information that would directly identify who you are. We offer you the opportunity to add that information if you wish for us to contact you, but we will not attempt to "find" you. Any future communications with you will only be initiated by you. And, we promise to never sell or share the information that you provide via this quote request form.

If you have submitted a quote on some other website, you may have entered just your email address, zip code, gender, and birthday. With just these parameters, the provider of those quotes could only provide "best guess" quotes. We can do that too, but there are many assumptions that could result in misleading quotes. The information that we request (including the "Recommended" fields) will result in your getting quotes that are accurate, without making lots of assumptions. It may take a little more effort on your part, but you will be rewarded with accuracy.

You can be assured that you will be submitting this form anonymously. When we say anonymous, we mean ANONYMOUS.

This is how we will provide you with our anonymous quote. We promise to never misues this information.



This is one of the primary fields that determine your premium cost. Each insurance company's rate tables are segregated by 5-digit zip code.



This is one of the primary fields that determine your premium cost. Generally, men have higher premiums than women. Blue Cross Blue Shield and UnitedHealthcare (AARP) have the same rates for men and women.

Male Female

This is one of the primary fields that determine your premium cost.



This is one of the primary fields that determine your premium cost. Some insurance companies base their premiums on the date that coverage will become effective (the Effective date), while other companies base their premiums on the date the application is signed (the Application date). Our quotes will assume that you are signing an application on the date that we make our quotations.



Only needed if you are NOT in your Open Enrollment Period (OEP). For clarification of your Open Enrollment period see our Commonly Asked Questions. In its rate calculation, AARP-UnitedHealthcare uses a complicated formula involving the relationship between Medicare Part B Effective Date and your proposed Effective Date of coverage. If this field is left blank we will assume that your Part B effective date is the first day of the month in which you turned 65.



Only needed if you are NOT in your OEP. Most insurance companies charge more if you have used tobacco in any form within the last 12 or 24 months.

Yes No

Only needed if you are NOT in your Open Enrollment period. Some insurance companies will not accept an application after your OEP if your height and weight do not comply with their accepted "Build Chart" parameters.



This information is NOT required. We hope you will share this information so that we can more casually reply to you with our emailed quotes.



This information is NOT required. Enter this field ONLY if you wish for us to contact you via phone.




 
(Required): This is how we will provide you with our anonymous quote. We promise to never misuse this information.
(Required): Zip Code is one of the primary fields that determine your premium cost. Each insurance company's rate tables are segregated by first-3-digit or 5-digit zip codes.
Male
Female
(Required): Gender is one of the primary fields that determine your premium cost. Generally, men have higher premiums than women. Blue Cross Blue Shield and UnitedHealthcare (AARP) have the same rates for men and women.
(Required): Age is one of the primary fields that determines your premium cost.
(Recommended): This is one of the primary fields that determine your premium cost. Some insurance companies base their premiums on age at the date that coverage will become effective (the Effective Date), while other companies base their premiums on age at the date the application is signed (the Application Date). Our quotes will assume that you are signing an application on the date we present our quotations.
(Recommended): This field is needed if you are NOT in your Open Enrollment Period (OEP). For clarification of your Open Enrollment Period see our Commonly Asked Questions. In its rate calculation, AARP-UnitedHealthcare uses a complicated formula involving the relationship between Medicare Part B Effective Date and your proposed Effective Date of coverage. If this field is left blank, we will assume that you Part B effective date is the first day of the month in which you turned 65.
Yes
No
 
(Recommended): Only needed if you are NOT in your OEP. Most insurance companies charge more if you have used tobacco in any form within the last 12 to 24 months.
FT
IN
Lbs
(Recommended): Your height and weight are needed if you are NOT in your Open Enrollment Period. Some insurance companies will not accept an application after your OEP if your height and weight do not comply with their accepted "Build Chart" parameters.
(Optional): Your name is NOT required. We hope you will share this information, however, so that we can more personally reply to you with our emailed quotes.
(Optional): Your phone number is NOT required. Enter this field ONLY if you wish for us to contact you by phone.
(Optional): If you have questions, comments, or would like to add additional information, please leave it here. This field is NOT required. We normally present monthly figures in our quote message. If you would like to see quarterly, semi-annual, or annual figures, indicate that preference in this field.