Health Insurance

When it comes to Health insurance, it is easy to get confused. Know how all the costs fit together and how best to compare one plan to another. To make matters worse, government gets to regulate health insurance through HMS and CMS and then trying to find out the best option get all the more complicated.  That is why you need David Topor and IntelliShield. David is able to sift through all the jargon and explain things in a way that makes it easy to understand and make a decision. Follow the links below and explore your options, then contact me and I will help you enroll.

Medicare

Medicare description & Link

Individual Insurance

Individual Insurance description and link

Ancillary Insurance

Ancillary insurance description and link

David Topor has been assisting clients with their individual Medicare Supplement Insurance questions and choices since 2009.  He prides himself on being able to simplify a very confusing selection process.  David promises to take the necessary time to listen to your questions and explain your choices in a easy to understand manner.  As a Independent Agent, David has the ability to get quotes from all major Insurance Companies which will guarantee that the customer gets the best policy available in the market.  David is happy to visit clients at their home and encourages other family members to join the meeting if requested.  Integrity is very important to David, and will never pressure a client to make a decision to enroll in a plan.  If you would appreciate this kind of personal attention, please call David directly at 865-441-1794. You will be glad you did.

Frequently Asked Questions

Do I need to change my plan every year?
Yes, I recommend to all my clients that they check for any Prescription Medication and Doctor Network changes during the Annual Election Period (AEP) each year from October 15th through December 7.
What is the best way to figure out the best plan for me?
The first step I take with my prospects and clients is to go to the Medicare.gov website and input their prescription drugs to determine which plans will cover their medication in it’s formulary and estimate the monthly expense.

For Medicare advantage prospects or clients, the next step is to check if their doctors and medical facilities are in the specific plan’s networks.

For Medicare Supplement prospects and clients, I run multiple quotes from my quote engine and compare Premiums, Industry Ratings, Rate History and pertinent market data.

The Last step is to determine any financial advantage between any 2 plans. The way I help clients do this is to write down all their anticipated medical visits and procedures for the year, then we plan for a few unexpected emergencies for good measure.  Once we have our list, we price out what the different co-pays will be for each plan we are considering.  The last step is to annualize the premium for each plan.  Once you total all the cost, you can determine which plan might have a financial advantage.

How can I avoid the Donut Hole?
Most seniors can not avoid the donut hole. Only those with low incomes can qualify and get “Extra Help” or “LIS” from Social security and will get any help paying prescriptions through the donut hole.

About 80% of Seniors have a annual combined prescription drug usage of $3,700 and therefor do not enter the donut hole.  However, once in the donut hole, the Drug manufacture will discount 60% for Brand names and 49% for Generic.  Seniors will exit the donut hole once their total annual out of pocket expense for prescriptions exceeds $4,950.   At that point they have entered catastrophic coverage and co-pays for all covered drugs will be just a few dollars per month.   Seniors are encouraged to visit Medicare.gov and use the interactive tool to estimate prescription drug costs and coverage.

 

Can I travel with my plans?
Yes.  All plans offer Emergency and Urgent care across the United States.

Some Medicare Supplement plans (C,D,F,G,M & N) offer foreign travel emergency care with limits

Which is better, a Medicare Supplement or a Medicare Advantage?
It is very important to understand the difference between Medicare Supplement Plans and Medicare Advantage plans. A Medicare Supplement Plan (AKA :  Medi-Gap plans) are designed to work in conjunction with Original Medicare and offer financial protection for seniors by covering the gaps (Deductibles or co-insurance) in Original Medicare. It is a secondary insurance that your provider will bill for the roughly 20% that Medicare does not cover.  As long as the doctor and facility take medicare, they will honor your policy as long as it has not lapsed.  Premium are locked in for a year and are guaranteed renewable but subject to annual age up increases.  Every 2-4 years insurance companies may increase their entire book of business across the board, but usually no more than 3-6%.  You are free to change your Insurance Company and/or Medicare Supplement Plan at anytime provided you can pass underwriting.  Medicare Supplements no-longer are offered with Drug coverage. Seniors need to enroll in a Medicare Rx Plan or they are subject to a penalty.

Medicare Advantage Plans are Medicare replacement plans offered by private insurance companies and vary from State to State. Plans are equally offered, regardless of age, to all medicare recipients as long as they do not have end stage renal disease. They usually offer affordable co-pays within their HMO or PPO provider Networks.  Most of these health plans offer a embedded prescription drug plan at one low premium.  All plans are required to cap expenses with an out of pocket maximum any where from $3,400-$6,700. Some plans offer extra benefits like Dental, vision and Gym memberships to add value to their plans. Plans are subject to change annually and therefor the Federal Government allows an Annual Election Period (AEP) for Seniors to reevaluate their changing needs.

Need Hassle Free Advice

If we didn’t answer all of your questions, feel free to drop us a line anytime.