Welcome

Lauren Mitchell

Principal Advisor

The team behind Dear Retirement is made up of qualified financial professionals who are passionate about helping individuals and families achieve their ideal retirements. Our mission is to help our clients protect and grow their assets through insurance products that position them to help achieve and exceed their retirement goals with minimum risk. Our first meeting is just a conversation with a beverage and a notepad. No pressure. No sales tactics. We want the opportunity to earn your business by demonstrating a thorough understanding of the strategies that could help guarantee your objectives are met.

Enrollment Form

Fill out this quick, two-minute form to allow us to help make your future as exciting as possible!

Welcome

Just a few questions, and 90% of the people that fill out the form can be signed up without talking to an agent. Feel free to included as much information or a little as you are comfortable with. The more information, the less likely you'll have to speak with an agent. All we ask is for you to include your name and phone number so we know how to get in touch.

Basic Info

Do you currently have Medicare, Medicaid, an employer policy or VA benefits? (you will NOT qualify for an ACA subsidy if you qualify for Medicaid/Medicare/employer or VA plan.

Yes

No

First Name *

Last Name *

Phone *

Email

Date of birth

Postal code

City

State

Gender

Address

Estimated Household Income for this Year

County

Employer

Do you claim any dependents on your taxes?

Yes

No

Are you married or single?

Married

Single

Tobacco User?

List of Prescription Drugs

Social Security Number

If you choose NOT to provide your Social Security Number today, you will have 90 days to provide your social to the Marketplace. If they do not receive your information within 90 days. The Marketplace will terminate your insurance We'll send reminders via email, text and phone calls once you've received your ID cards

How many people need coverage?

1

2

3

4

5

6+

Additional Info

Information for other people seeking coverage

Almost There

I give Dear Retirement permission to access my healthcare.gov application and submit it for a $0 premium health insurance.

Yes

Signature

By clicking 'I agree', you consent to be contacted by a Dear Retirement representative. You also agree to our Terms of Use and Privacy Policy. You may opt-out at any time by replying 'STOP' to any of our messages. Standard message and data rates may apply. Please note that opting out will not affect any messages that have already been sent. Your information is 100% secure and will NOT be given or sold to anyone else.

Check To Opt In: *

I agree

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info@dearretirement.com | Phone: 800.615.1440 | Fax: 888.845.1504

857 Northeast Main St., Simpsonville, SC 29681 | Get directions

info@dearretirement.com | Phone: 800.615.1440 | Fax: 888.845.1504

857 Northeast Main St., Simpsonville, SC 29681 | Get directions