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Coverage Gap Assessment
Answer a few guided questions to estimate whether your household may have a protection gap.
Section 1
Let’s start with who you’re protecting
What is your age?
Marital Status
Single
Married / Partnered
Divorced
Widowed
Do you have anyone who depends on your income?
Yes
No
Number of Dependents
Ages of Children
Special Needs Dependent
Yes
No
Section 2
Tell us about your income
Annual Income
Monthly Take-Home
Employment Type
W2 Employee
Self-Employed
Contractor / Gig
Retired
Income Stability
1: Very unstable
3
5: Very stable
Section 3
Let’s protect your home
Housing Status
I own my home
I rent
Mortgage Balance
Monthly Mortgage Payment
Years Remaining
Select one
<5
5–10
10–20
20–30
Monthly Rent
Rent Protection Duration
Select one
1 year
3 years
5 years
10 years
Section 4
What does it cost to run your household?
Groceries
Utilities
Car payments
Insurance
Childcare
Debt payments
Other
Total Monthly Expenses:
$0
Section 5
What future costs should we protect?
College Funding
Yes
No
Cost per Child
Select one
$25k
$50k
$100k
Custom
Custom Cost per Child
Would you want your debts fully paid off?
Yes
No
About how much total debt do you have?
Select one
<$10,000
$10,000-$25,000
$25,000-$50,000
$50,000-$100,000
$100,000+
Not sure
Would you want to leave money behind for your family?
Yes
No
About how much would you want to leave behind?
$10,000 (basic final expenses)
$25,000
$50,000
$100,000
$250,000+
Section 6
Do you already have protection?
Existing Life Insurance
Yes
No
Coverage Amount
Years Remaining
Select one
<5
5–10
10–20
20+
Type
Term
Whole
Work policy
Section 7
What are your biggest concerns?
Biggest Concern
Losing income
Medical bills
Mortgage/rent
Final expenses
Emergency Savings
<1 month
1–3 months
3–6 months
6+ months
Section 8
Let’s match this to your budget
Monthly Budget
<$25
$25–$50
$50–$100
$100+
Preference
Lowest cost
Balanced
Long-term coverage
Section 9
Let’s plan your future income
When do you expect to need income beyond your current earnings?
Within 1-2 years
3-5 years
6-10 years
10+ years
Already retired
Section 10
Guaranteed income
Do you expect to receive Social Security?
Yes (I know my estimate)
Yes (not sure amount)
No
Estimated Monthly Social Security
Will you receive a pension?
Yes (enter monthly)
No
Monthly Pension Income
Other Guaranteed Monthly Income
Section 11
Retirement savings
About how much have you saved for retirement so far?
Select one
<$25k
$25k-$100k
$100k-$250k
$250k-$500k
$500k-$1M
$1M+
Are you actively contributing to retirement savings?
Yes, regularly
Occasionally
Not currently
Section 12
Do you already have protected income set up?
Do you currently own any annuities or protected income products?
Yes
No
Not sure
Type of Annuity
Fixed Indexed Annuity (FIA)
Fixed Annuity
Income Annuity (SPIA/DIA)
Variable Annuity
Not sure
Approximate Value
Select one
<$50k
$50k-$100k
$100k-$250k
$250k-$500k
$500k+
Producing Income?
Yes (currently paying income)
Not yet
Not sure
About how much monthly income does it provide?
<$500
$500-$1,000
$1,000-$2,000
$2,000-$4,000
$4,000+
Not sure
Enter exact amount (optional)
Exact Monthly Income
Section 13
Income preference
In retirement, would you prefer:
Guaranteed income I can’t outlive
Flexible withdrawals I control
A mix of both
Section 14
Market risk sensitivity
What worries you most about your savings?
Market losses
Running out of money
Inflation
Not having steady income
How comfortable are you with market ups and downs?
1: Very conservative
3
5: Aggressive
Section 15
Liquidity preference
How important is access to your money?
I need full access anytime
I want some flexibility
I’m okay locking some funds for guarantees
How much of your savings could you safely allocate?
None
Less than 25%
25-50%
50%+
When would you want protected income to begin?
Immediately
Within 5 years
5-10 years
Not sure
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