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Wenatchee, WA 98801

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What are the essential coverage for Health Insurance?

Posted on by Matt McColm

What Are the 10 Essential Coverage for Health Insurance?
(And Why You’ll Want Suzie at Wenatchee Insurance on Speed Dial)

Family Health Insurance with 10 essential coverage

Health insurance can feel like a magical mystery tour, except it’s more like a trip through paperwork and less like a rock concert. But don’t worry! Suzie from Wenatchee Insurance is here to save the day, kind of like a superhero, but instead of a cape, she has a computer full of insurance plans. Let’s take a look at the 10 essential coverages that every health insurance plan must have (thanks, Affordable Care Act!), and how they make life easier here in Eastern Washington.

1. Ambulatory Patient Services (aka Your Everyday Doctor Visits)

You wake up, sneeze three times, and suddenly, you’re Googling “Is sneezing a sign of a rare disease?” Instead of spiraling down the rabbit hole of WebMD, you can make a quick visit to your doctor. Ambulatory services cover routine check-ups and visits to specialists. Suzie’s here to make sure you’re covered whether you’re seeing Dr. Jones down the street or a specialist for your “seasonal allergies” (also known as dust from last year’s ski gear).

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2. Emergency Services (When Skiing Goes Wrong)

Imagine this: you’re having the best day at Mission Ridge, catching air and looking like a pro. Then… BAM! You misjudge a jump and suddenly find yourself needing an ambulance. Don’t panic—your health insurance has you covered for all those “Oops, I did something dumb” moments. Emergency services mean that your insurance will handle that surprise ER trip.

3. Hospitalization (If You Need More Than Just a Band-Aid)

Okay, so your skiing mishap turned into something bigger when you escaped Bigfoot on Stevens Pass. Maybe you need surgery or a few days in the hospital. Hospitalization coverage makes sure you don’t have to start a GoFundMe to pay your medical bills. Let’s find you a plan with a higher success rate.

4. Maternity and Newborn Care (Because Babies Don’t Come Cheap)

Expecting a baby? Congratulations! Maternity and newborn care are essential coverages, so whether you’re welcoming your little bundle of joy in Wenatchee or elsewhere in North Central Washington, you won’t have to sell the farm for the newest hand. Suzie’s got the inside scoop on which plans make it easier to manage prenatal visits, delivery, and all those newborn checkups. Postnatal Care is important and we have additional resources in Washington State.

5. Mental Health and Substance Use Disorder Services (We All Need Therapy Sometimes)

Let’s face it—life can be stressful. Maybe you’ve binge-watched House one too many times and are now convinced you have every rare condition ever featured on the show. Good news! Your health insurance covers mental health services, so you can talk to a therapist and work through your House-induced hypochondria. Happy brain coverage while easier than before the ACA, is still not always the fastest hunt in Eastern Washington.

6. Prescription Drugs (AKA The “Why Is This So Expensive?” Coverage)

When your doctor prescribes medication, you shouldn’t have to choose between paying for your meds or your next Netflix subscription. Prescription drug coverage means you’ll get help with the cost of necessary medications. Suzie can point you to plans that cover the things you need, whether it’s allergy meds, insulin, or that mystery cream for the rash you got hiking up Saddle Rock.

7. Rehabilitative and Habilitative Services (Getting You Back on Your Feet, Literally)

If your big skiing adventure left you needing physical therapy, you’re in luck. Rehabilitative services are designed to help you recover from injuries, illnesses, or even surgeries. Suzie will ensure your plan covers those sessions where you learn to bend your knee again without yelping like a golden retriever stepping on a Lego.

8. Laboratory Services (Testing Without the Guessing)

Routine blood work or diagnostic tests? No problem! You don’t have to skip your annual check-up at Confluence Health just because you’re worried about the cost of tests. It seems like when you get over forty the doctors have a fleet of tests for you. There are a variety of options when it comes to how an insurance company handles this.

9. Preventive and Wellness Services (Keeping You from Becoming a WebMD Expert)

Preventive care is like that nagging friend who reminds you to take care of yourself—except now it’s your insurance! Whether it’s vaccines, screenings, or a flu shot from your local pharmacy, preventive care is 100% covered. Little work now to prevent the big job later.

10. Pediatric Services, Including Oral and Vision Care

Got kids? Your insurance will cover regular check-ups, dental care, and vision tests for them. Suzie can help you find a family-friendly plan so you don’t have to pay out-of-pocket when little Johnny needs glasses because they spent too much time squinting at their phone playing Monopoly Go!

Conclusion

Choosing the right health insurance plan doesn’t have to feel like running a marathon in flip-flops. With Suzie and Wenatchee Insurance, you’ll have an expert who can help you navigate the corn maze of coverages and find a plan that fits your needs. Whether you’re in Wenatchee, Colville, or anywhere in Eastern Washington, you’ve got someone in your corner who knows the ins and outs of health insurance—and has a heck of a butterfly collection!

While we do have Open Enrollment from November 1st through January 15th, there are also Special Enrollment Periods (SEP). SEP are documented reasons like losing coverage from a job, low income, getting married, or even a tribal affiliation. Suzie likes to run the application to see if one of the conditions can trigger an immediate enrollment or else we are prepared for the next Open Enrollment Period in fall.

You do not have to go alone when you have Suzie on your insurance team.

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Home Health Medicare Car Dental Prescription insurance corndog

Topics: health insurance, Medicare, Medicare Advantage, health alliance, wellcare, Molina, humana, Suzie,  Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth, Quincy, Cashmere, Entiat,

How to hire or fire your broker on the Healthplanfinder

Posted on by Matt McColm

Suzie and Matt get new clients on a regular basis that have no idea who their broker is or don’t like them. In other states, there have been rogue broker swaps so we are keeping our eye out for this in Washington .Before we work on an account, we request a person’s permission. It is important to note that for insurance the clients owns the relationship this is especially true for plans on the Washington Healthplanfinder.

To look at your account about a week prior to open enrollment and a week after, we have to be attached to your account as the broker of record.  At Wenatchee Insurance, we don’t charge fees and are year-round so it is securing your customer service for the year. If we are not attached then we will not receive funds for the year from the insurance companies. (Yes, it keeps the lights on so we can lend a hand.)

You have a couple of options.

  1. You can log onto your desktop.
    1. Here is the log on screen on the lower right is the the manage broker button to select.Here is what a selected broker looks like.
Healthplanfinder Washington find broker

2. You should be able to read who your broker is:

3. When you select a broker it will look like this. Make sure that you go all the way through your policy.

  • Call into the Healthplanfinder 1-855-923-4633.
    • You can request to fire the broker of record.
confirm broker on healthplanfinder

Brokers in the same organization can lend a hand on accounts answering questions and updates. Yes, it means you have even more customer service. You can also have a navigator as well as a broker for additional service.

During the Open Enrollment Season November 1st through January 15th Suzie and Matt work many long hours where support to change broker of record on accounts is impossible if you do not know your passwords. It is why we recommend checking before a weekend or off-hour appointment.

chat with Suzie
simple process for insurance
Wenatchee Insurance simple process

If you find yourself with someone that you didn’t not select then an easy way is to go to the message center. They have an search feature for In-Person Help Update. If the person that is listed as your broker does not appear on your most recent option then a change is in order.

Then there you go, how to know who you consented to be your broker of record.

Washington Residents: Discover If You Can Really Get Health Insurance at No Cost!

Posted on by Matt McColm
Apple Health or medicaid is free health insurance

Nancy, a resident of the bustling town of Wenatchee, sat staring at an open laptop flashing an array of confusing premium options for her potential health care coverage for the upcoming year. Not only was the screen dizzying to her, but the monthly premiums felt like a gut punch given her household budget. While staring blankly at the screen, the pressing question of how can you get health insurance she can afford weighs heavily on her mind. This is a common thread of worry among many of our Chelan County neighbors during this open enrollment season, especially when you think about what your kids need. As she began looking at the screen, searching for clarity, she wondered if there were any free plans that her neighbor had talked about. Nancy represents the legion of Washingtonians battling the confusion over health care costs. Especially when insurance companies get involved. But like most, she was unsure what to do and definitely didn’t want to put her contact information into a website knowing what would happen to her phone in the aftermath. If only she could find a solution to her health plan options.

What is Free Health Insurance?

With the arrival of open enrollment (November 1st) , Washingtonians are faced with pivotal decisions regarding their health insurance for the coming year. The Suzie @ Wenatchee Insurance and our other agents are inundated with concerns about soaring prices and questions about whether a doctor is covered by individual health plans. The relentless queries, dominated by the pressing question, “Can you get free health insurance in Washington?” echo through our office. This concern is not unfounded. Many residents wonder if the concept of free health care is a tangible reality or a mere mirage in the desert of healthcare options. During this period, the uninsured ponder whether they are flirting with financial peril, and the question of “Is it a scam?” is a regular chorus.

chat with Suzie

Who Can Get Free Health Insurance in Washington State?

It turns out that free health insurance in Washington isn’t a mythical creature—it does exist for those who fit the mold. Washingtonians may qualify for various health insurance programs at no cost, from government-sponsored initiatives to specific plans within the ACA Marketplace. This means that free health insurance isn’t just a fleeting hope but a tangible reality for some, provided they meet the necessary eligibility criteria, which include specific income requirements and participation in government programs. And even if free isn’t available, an affordable health plan may be within reach.

Washington Residents: Discover If You Can Really Get Health Insurance at No Cost!

Do I Have To Have Health Insurance In Washington?

While Washington State doesn’t impose a penalty for those sans health care coverage, many like Nancy understand that this freedom comes with its own risks. The absence of a safety net can lead to financial turmoil in the face of unexpected medical issues. It’s not mandated, but the sheer unpredictability of life steers many towards exploring the various alternative health plan options available, such as private health plans or policies from ACA Exchange, to mitigate the potential financial strain. But we still have many adults without health insurance in this state.

Types of Health Insurance Available in Washington

Washingtonians are presented with many healthcare program options. From the Marketplace Exchange brimming with plans to the security offered by off-exchange plans, there’s something for everyone. Wenatchee Insurance recommends maintaining some level of health care coverage because, as life has proven time and again, it can indeed come at you fast.

ACA Marketplace Exchange Plans

For many residents, ACA Marketplace or Exchange Plans are a place of hope for containing the cost of health insurance. The costs of marketplace coverage can be offset by federal government subsidies, which is a massive benefit for families struggling with the pressure of inflation. An added benefit is that eligibility for these plans cannot be denied for any pre-existing conditions or for people with disabilities. The Washington Healthplanfinder is an integral part of the healthcare landscape in Washington, ensuring a safety net is available for those who need it most.

Short Term Medical Plans

Short Term Medical Plans are not offered in Washington state. The Washington Office of Insurance would love for you to notify you if someone is offering a short-term plan.

Catastrophic Health Plans

As of July 2024 there were no Insurance Companies offering a Catastrophic Healthcare Plan in Washington State. When they have been available they had an age limit of under 30. Strangely, the majority of people asking for them were over that age.

Need Help With Washington Health Insurance?

chat with Suzie

Requirements for Free Health Insurance in Washington

Free health care services in Washington isn’t a giveaway—it’s a carefully regulated benefit with specific qualifying criteria based on age and income. Programs like Apple Health (Medicaid) or CHIP have stringent eligibility requirements, and while the ACA Marketplace is more broadly accessible, the cost of plans is influenced by a range of qualifying factors. And just because your monthly premiums are free, you can still have costs for doctor visits or hospital care. Let’s look at the three major requirements.

Income Requirements

The pathway to free health insurance in Washington is paved with household income requirements. It’s essential to understand the various types of income, from unemployment benefits to monthly income, which are taken into account when determining eligibility for programs like CHIP and other free health insurance options. If your family is at or below the federal poverty line from an annual income estimate, you will be in line to qualify for Apple Health or CHIP. If your annual household income is above that amount, your household may qualify for Cascade Savings which are state credits that can further reduce your premium cost in some cases to zero.

Apple Health Free Health insurance Washington Medicaid

Age Requirements

Age is a determining factor for free health insurance eligibility in Washington State. For children and young adults, Apple Health and CHIP offer low-cost solutions, while seniors find assistance through Medicare. The Health Insurance Marketplace also provides age-specific options, ensuring a broad spectrum of coverage possibilities for Washingtonians.

Resident Status

The final piece is your status as a permanent resident of Washington. If you have a home in another state where you file your taxes, your ability to obtain a Marketplace or Exchange plan here in Washington is removed no matter how limited your household income might be. It’s vitally important to understand this if you are seeking financial assistance with your health care plan.

Note Beginning in 2024, Washington became the first state to be able to enroll people into healthcare regardless of immigration status using the Healthplanfinder. This includes DACA or Dreamers.

Who Can Help Me Get Health Insurance?

We understand that all of this can be incredibly confusing. Nancy certainly was confused by not only choosing a primary care doctor, but also the types of plans available. Local, experienced health insurance agents are the allies Washington need when navigating the complex world of health insurance. They not only understand the individual insurance options available to you, but they also understand which health care providers accept which affordable health insurance plan. And sometimes, a low-cost plan may serve better than a no-cost option. If your objective is to minimize total out-of-pocket expenses, not just monthly premiums, these affordable health service options must be considered. Wenatchee Insurance employs experts who can help tailor the right plan for your individual needs.

Speak to Wenatchee Insurance

At Wenatchee Insurance, our independent agents work tirelessly for the people of Washington. We strive to provide the education necessary to navigate the myriad of options available. Our goal is to pair you with a plan that not only covers your healthcare needs but also aligns with your financial situation.

For Nancy and countless others, the journey to uncover the right health insurance is laden with questions and uncertainties. Click the Button Below to Navigate Through Washingtons’ Health Insurance Plans and Find Out If Free Coverage Is in Your Future! Let us help you demystify the options and uncover the path to your ideal health insurance plan for 2024 and beyond.

chat with Suzie
Insurance Bundle

Topics: health insurance, ACA, catastrophic health coverage, ACA Alternatives, prescription coverage, private health insurance, short term, apple health, DACA, Okanogan, Grant, Chelan, Douglas, Quincy,

Should You Update Your Health or Medicare Plan During the Fall Enrollment Period?

Posted on by Matt McColm
Suzie with the Wellcare banner on Mission for Fall Enrollment

Let Suzie from Wenatchee Insurance Be Your Enrollment Guide!

It’s that time of year again—leaves are falling, pumpkin spice is everywhere, and it’s officially fall. Suzie has started hosting the feathers to help people find our Mission street office.

While you’re busy sipping on that latte, don’t forget that it’s also Medicare and health insurance open enrollment season. Yes, it’s the magical time of year when you can review, tweak, or overhaul your health plan to prepare for the coming year. If you’re scratching your head, unsure about when to update your Medicare or health plan, don’t worry—Suzie from Wenatchee Insurance has been a resource in Wenatchee for over a decade!

set appointment with Suzie

Why the Fall Enrollment Period is Important

The Annual Enrollment Period (AEP) for Medicare runs from October 15 to December 7, while health insurance marketplace open enrollment typically starts around November 1 and ends mid-January (for Washington State). This window is your chance to make changes that could save you money, improve your coverage, or protect you from unexpected healthcare surprises down the road.

But here’s the catch: if you snooze, you lose. Once the period closes, you may be stuck with your current plan for the entire year—unless you qualify for a special enrollment period. So, grab that calendar and select an appointment today. Trust Suzie from Wenatchee Insurance to help make the process as painless as possible—she’s even got some great jokes up her sleeve to keep things fun!

Please note if your insurance plan is leaving then you may have extra time to enroll!

Installed the Wenatchee Insurance sign for Suzie
While we liked the old one, the new sign sparkles better.

When Should You Update Your Health or Medicare Plan?

Here are some key scenarios where updating your plan during the fall enrollment period makes perfect sense.

  • Your Plan has left

It takes two to tango and sometimes the Health Insurance Companies cannot reach an agreement with the local doctors. If you have Medicare then you can double check on Medicare.gov the first couple of weeks in October. In Washington state, the health plans go through an approval process starting about June every year. Both are required to send out notices. When your plan leaves then you may have good unexpected options.

  • Your Health Has Changed

Did your health take an unexpected detour this year? Maybe you discovered you’re allergic to dogs, but you adopted three Corgis because you couldn’t resist their fluffy tushies. Or perhaps you’ve been diagnosed with a condition that requires more trips to the doctor or prescription medications. If your healthcare needs have changed, it’s time to update your health plan.

Health Insurance Medicare Advantage Wenatchee Suzie

For Medicare enrollees, this is especially important. If you’re on Original Medicare but now need more comprehensive prescription coverage, it might be time to consider a Medicare Advantage Plan or adding a Medicare Supplement with a Part D Prescription Drug Plan. Suzie can help you explore your options and make sure your plan aligns with your health needs.

  • You’ve Moved or Plan to Travel More

Did you recently move to a charming little town like Winthrop where your internet is slower than molasses, but the mountain views are worth it? If so, your current plan may not cover your new healthcare providers. Or maybe you’re spending more time traveling and need a plan that accommodates your jet-setting lifestyle (or in Suzie’s case, jet-fueled coffee).

Medicare Advantage Plans and some health insurance policies are region-specific, so updating your plan can ensure that you’re covered no matter where you are—or where you’re heading.

  • Your Current Plan is Draining Your Wallet

If you’re starting to feel like your health insurance premium is eating up your budget for pumpkin spice lattes, it’s time for a change. Fall enrollment is the time to shop around for more affordable options.

Please note that Medicare Supplement Plans (Medigap) can be shopped year-round.

Maybe your plan has been creeping in some fee increases or out-of-pocket costs over the last couple of years that now feel like a second mortgage. Suzie can help you compare plans and find one that offers better value for your money. Who knows—you might even be able to upgrade your coffee from regular brew to that fancy almond-milk version you’ve had your eye on!

  • You Want to Try Something New

Health plans aren’t tattoos—you can change them! You never know if a new plan has arrived with different benefits if you never look. If you’re simply curious about trying a new type of plan or want to explore the extra benefits of a Medicare Advantage Plan (like vision, dental, or hearing coverage), fall enrollment is the time to do it. Suzie can walk you through the options, making the process as smooth as your favorite blend of coffee.

Suzie with Wenatchee insurance can change medicare and health insurance plans.
  • Get Help From Suzie at Wenatchee Insurance

Whether you’re updating your plan due to health changes, moving, financial concerns, or just wanting something new, Suzie at Wenatchee Insurance is here to help. She knows that health insurance can be confusing, and she’ll make sure you understand every option available—without boring you to tears. Plus, with her sense of humor, she’ll turn what can feel like a tedious task into a conversation you’ll enjoy.

So this fall, while you’re sipping your seasonal drinks and raking leaves, take a moment to think about your healthcare needs. And when you’re ready to make some updates, give Suzie a call at Wenatchee Insurance. She’ll have you laughing your way to better coverage in no time!

chat with Suzie

What Happens If I Miss My Initial Enrollment Period (IEP)?

Posted on by Matt McColm
original medicare, medicare advantage and part d initial enrollment

Missing your Initial Enrollment Period (IEP) is like missing the last ferry out of Chelan to Stehekin—you can still get where you’re going, but it might be a bit more complicated and costly. The IEP is your first opportunity to enroll in Medicare, and it spans seven months (the three months before you turn 65, the month of your birthday, and the three months after). If you miss this boat, you might face late enrollment penalties.

Suzie tip: If you are turning 65 in October, November or December then select your appointment early as your Initial Enrollment overlaps with the Annual Enrollment Period and it is a very busy time.

But don’t worry, Suzie from Wenatchee Insurance is here to help you catch the next one. She’s like the friendly dock attendant who knows all the schedules. If you’ve missed your IEP, Suzie can help you sign up during the General Enrollment Period (GEP), which runs from January 1 to March 31 each year. However, enrolling late could mean higher premiums for Part B, like paying extra to charter a private boat instead of catching the ferry.

What if I am working with a employer & have a health plan?

Suzie can also check if you qualify for a Special Enrollment Period (SEP), maybe because you were still working and had employer coverage. This is like getting a free ticket for the next ferry because of a rain check.

So, if you’ve missed the Medicare boat, don’t panic—Suzie will make sure you find the next best option to get you where you need to go.

Suzie tip: If you have a plan on the Washington Healthplanfinder, the minute that you become Medicare eligible then you lose the advanced premium tax credits. It is worthwhile to talk to Suzie before this occurs.

Suzie has been assisting people in Washington state for over a decade selecting Medicare Prescription and Medicare Advantage Plans. She has people selecting her months in advance for these updates. If you do not see her available then call and we will do our best for a personalized appointment.

chat with Suzie
Suzie Medicare Initial Enrollment, Annual Enrollment or Special Enrollment

Topics: health insurance, Medicare, Medicare Advantage, Wenatchee Insurance, Suzie,  Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth, Quincy, Cashmere, Entiat,

How Do You Change Your Health Insurance Policy After Moving to a New State?

Posted on by admin

Relocating to a new state may be thrilling, but it comes with a checklist of duties, which includes updating your health insurance policy. At Wenatchee Insurance Agency in Wenatchee, WA, we understand the significance of seamless transitions. Let us guide you through the steps to modify your health insurance following a move.

Understand State Regulations

Each state has its health insurance marketplace and regulations. When you move, adhering to these new rules is crucial to ensure compliance and complete coverage. Some states might provide different benefits or mandate specific types of coverage. Acquainting yourself with these changes can help you avoid any lapses in coverage.

Notify Your Insurance Provider

Once your relocation is complete, notify your current insurance provider as promptly as possible. This step is pivotal because your present plan may not offer services in your new state. Your provider can guide you on whether you can stick to your existing plan or if you need to opt for a new one.

Explore The New Insurance Options

If you discover that you need a new policy, commence exploring options in your new state. The Health Insurance Marketplace is an excellent place to start. During the triggered Special Enrollment Period due to your move, you can evaluate plans and find one that caters to your needs and financial capacity.

Seek Professional Guidance

Untangling insurance changes can be intricate. However, consulting with a local insurance expert can simplify the process. At Wenatchee Insurance Agency, we’re here to help residents of Wenatchee, WA, find the best health insurance solutions.

Contact Wenatchee Insurance Agency Today

Ready to modify your health insurance policy following your relocation? Contact the Wenatchee Insurance Agency in Wenatchee, WA today for tailored assistance. Ensure your coverage meets your new state’s requirements.

Do I Need a Medigap (Medicare Supplement) Policy?

Posted on by Matt McColm

Ok, imagine you’re at the Okanogan Valley Farmer’s Market in the American Legion Park, picking out some juicy apples. Original Medicare is like paying for the apples themselves. You could be forgetting some things. What about the cost of the basket to carry your apples in, or maybe you want that delicious caramel sauce for dipping? That’s where Medigap, also known as Medicare Supplement Insurance, comes in—it covers the extra costs that Original Medicare doesn’t, like copayments, coinsurance, and deductibles.

Suzie from Wenatchee Insurance is like your personal shopper, helping you decide if you need that extra basket (Medigap policy) to make your Medicare experience complete. Let’s say you have Original Medicare and you end up needing frequent doctor visits, or you’re planning on a lot of travel, maybe visiting family in Winthrop or Ellensburg. A Medigap policy could save you from those unexpected out-of-pocket costs.

Suzie can compare the various Medigap plans for you, much like sorting through different apple varieties to find the perfect one. With her help, you’ll know if you need the extra coverage and which plan fits your budget and lifestyle.

Do not forget Prescriptions

Suzie tip: Prescriptions Coverages are not covered by Original Medicare and if you skip it then you may have a late enrollment penalty later. Worth the conversation.

So, whether you’re staying close to home or hitting the road, Suzie will make sure you have the right Medicare “basket” for your journey over the river and through the woods.

Medicare Supplements are an important consideration during your initial enrollment

Suzie has been assisting people with Medicare plans for over a decades. She brings over twenty years experience as a pharmacy technician and saw first hand the difficulties people had with an incorrect plan. By answering the coverages and questions on the front end, many of the problems can be solved before a person goes to use their medicare policy.

appointment with Suzie
Enrollment Periods Wenatchee Suzie Health Insurance

Topics: health insurance, Medicare, Medicare Advantage, Suzie,  Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth, Quincy, Cashmere, Entiat,

How Do I Get Health Insurance Before Medicare Kicks In?

Posted on by Matt McColm
Health Insurance

Congratulations on deciding to and being able to retire. You’ve spent a lot of blood, sweat, and tears to get you here, working and saving your pennies. It’s an accomplishment that should not be glossed over or minimized. But if you are like countless other of our neighbors in Eastern Washington who decide to retire a bit before the age of 65, there is one glaring question that comes up. How do you obtain health insurance until Medicare kicks in at 65?

chat with Suzie

Many of the benefits and solutions to your retirement are neatly drawn up and planned out. Even Social Security can start prior to 65 if you want. But health insurance can definitely prove to be tricky if you or your spouse do not qualify for Medicare age wise. So the question that we get frequently from Washingtonians, is how can I get health coverage before we qualify for Medicare. The great news for you is that Wenatchee Insurance has a plan to help you obtain Medical Insurance prior to turning 65 that can fit your personal needs.

Keys To Finding A Great Health Insurance Plan


When you begin to look at your options, we typically break them down into two main options.

  1. Health Insurance Marketplace Plans
  2. COBRA

The key to choosing the best option for you comes down to a series of questions about your situation and needs when considering a health plan. The answers to these questions make it easy to slot into one of the four options listed above. Let’s explore those questions which are the keys to finding a great health insurance plan.

Do you have a pre-existing condition that requires you to have specific hospitals, doctors, or prescription drug coverage in-network with your health insurance coverage?

Are you comfortable paying for medical costs out of pocket when they arise periodically?

What period of time do you need the coverage for to get you to your retiree health benefits?

What is your expected household income since it can affect your health insurance premiums?

How do you consume health care including doctor visits, prescription drug plans, and preventive testing?

Pre-Existing Conditions, Networks, & Time Horizons


The harsh reality of an on-going treatment plan for a diagnosis or a pre-existing condition that you have or are receiving regular treatment for will go a long way towards shaping which medical insurance that you choose to utilize going forward. Private health plans and Catastrophic health plans are immediately eliminated in most cases as they utilize underwriting to determine if they will extend an offer of medical coverage. Given that reality, we are left to compare COBRA plans and plans from the Washington Healthplanfinder.
In the state of Washington, COBRA could be your best option if your budget can afford premiums. That is because your employer group health plan may have a better deductible, maximum out of pocket, prescription drug coverage, and more robust networks of providers than the marketplace plans. The downside to COBRA plans is that you will be time bound to a maximum of 18 months of coverage when you leave your employment. (You can change during Open Enrollment as well). But if you’re in the middle of cancer treatment that 18 month window being covered and knowing that your health coverage is set will provide peace of mind even in spite of a perceived substantial monthly premium.
Conversely, the change in employment status when you retire, or the end of the COBRA time period means that you will qualify for a Special Enrollment Period and can elect to migrate to the marketplace plans at either time. That allows you to keep medical coverage via an affordable health insurance plan when the time is right.

health or medicare enrollment suzie makes it easier

How Do You Use Health Insurance?


Most people who have been on employer group health plans for prolonged periods of time have a tendency to not consider how they use their health care. They know that they schedule a doctor’s appointment or procedure knowing that the insurance company is going to cover the medical expenses regardless of their health conditions. As you make the transitions to retiree health plans here in North Central Washington you begin to realize that the true costs of medical expenses become more real because premiums will likely rise and out of pocket costs may escalate. Understanding that trading a lower premium while paying out of pocket for essential health benefits may make more sense if the math works out.


Or maybe the premium savings on a high deductible health plan means that a quiet year for health care saves you a lot of money even though you paid for that urgent care visit. Or maybe paying cash for a generic maintenance drug because of reduced prescription drug coverage can save you money throughout the year. All of these scenarios have to be considered with choosing your new health insurance policy

How Do You Know Which Plan To Choose?


Fortunately, the independent insurance agents at Wenatchee Insurance have many options available to meet your needs. Those agents use a matrix of options based around these basic questions so that you can find the right health coverage for you while limiting your out of pocket costs for medical expenses. We can help you navigate enrollment periods, premium tax credits, prescription drug plans, health savings accounts, and your retirement budget. It is essential that we work with you to understand the answers to the questions posed to you so that we can make the best recommendations possible.

chat with Suzie
Insurance Bundle

Topics: Health Insurance, Apple Health, Ambetter, Lifewise, Community Health Wenatchee Insurance, Delta Dental, Retirement, Suzie, Enrollment, Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth,

How much is health insurance cost for 2025?

Posted on by Matt McColm
Health insurance Open Enrollment

The Office of the Insurance Commissioner has approved rates for 2025. Washington state is looking at an average of 10.7% rate increase for 2025 for individual health insurance. For many people this will be a first look at what to expect before the Open Enrollment.

November 1 – December 15 for Health Insurance 2025 plans.

Why is this occurring?

The cost of care is a big factor in driving the costs. All the plans spent more than 80% of premiums on claims. The Affordable Care Act requires the insurance companies to either spend at least 80% on claims or else they have to issue rebate checks to the policy owners. A couple of the companies had significant risk adjustment payments that drove down their profitability as well. The Office of Insurance has made a five suggestions on how to lower the rates and we will see if the state legislatures respond.

How does it impact me?

It is important to shop your health insurance plans. Since you had a birthday then you know that the price went up. Also since we are dealing with an average, some plans may increase while others decrease to arrive at that average. If your tax subsidy is small then you will notice the increase more. If you qualified for a plan regardless of immigration status then you will notice the increase more because you don’t receive the federal subsidies.

Why setting an appointment early is important?

Suzie and Matt are seeing big changes for 2025 when it comes to Insurance.

  • Massive Medicare Prescription Changes from Inflation Reduction Act
  • Dreamers have a Special Enrollment starting November 1st
  • Average increase of over 10% for individual health.

Medicare Annual Enrollment runs October 15th through December 7th.

Healthcare Open Enrollment runs from November 1st through December 15th for plans starting January 1st. (Enrollment of Dec 16 through Jan 15 has a starting date of Feb 1st!)

Suzie and Matt have been assisting people understand and enroll in health insurance for over a decade in Wenatchee. They do not charge fees and answer questions throughout the year.

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Wenatchee insurance is a independent agency that offers a wide variety of products for our clients.

Do I Need to Enroll in Medicare if I Am Working in Washington State?

Posted on by Matt McColm
Medicare Advantage or Medigap Suzie at wenatchee can help

The Question: So, you’re still clocking in at the 9-to-5 grind, enjoying those free office donuts, and now, on top of that, Medicare is knocking on your door. You’re probably thinking, “Do I really need to enroll in Medicare while I’m still working?” Well, don’t worry—Suzie from Wenatchee Insurance has got your back, and she’s got answers that are as clear as a sunny day in North Central Washington!

1. Is Your Employer Big Enough to Be a Bouncer?

  • Large Employers (20 or more employees): If your employer is big enough to need name tags at the company picnic, they probably have a health plan that stays primary while Medicare takes a back seat. You can think of Medicare Part B as that friend who always offers to pay, but you don’t really need them to—yet. Suzie suggests you might want to grab Part A (it’s free, like a leftover doughnut in the break room), but hold off on Part B if you’re happy with your employer’s coverage.
  • Small Employers (fewer than 20 employees): If your employer is more like a cozy family reunion where everyone knows your middle name, then Medicare will want to be your primary insurance. Suzie says this is the time to roll out the red carpet for Medicare Part A and B, or you might find yourself stuck with some unexpected bills—like when you forget it’s your turn to bring snacks to the staff meeting.
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2. Are You Playing HSA Roulette?

  • HSAs and Medicare: A Tricky Tango: If you’re still playing the HSA game, you’ve got to be careful. Suzie warns that enrolling in Medicare will throw your HSA contributions out the window faster than your New Year’s resolutions. If you’re not ready to give up on that sweet, sweet HSA money, you might want to keep Medicare at bay for a little while longer.

3. Dodge the Medicare Penalty Like a Pro

  • Suzie’s Tip: If you think you’re too cool for Medicare Part B, think again! Suzie’s seen too many folks who thought they could outsmart the system, only to end up paying a penalty that follows them like a persistent telemarketer. So unless you’re into paying more for less, make sure you don’t miss that Special Enrollment Period (SEP).

4. Special Enrollment Period: Your Get-Out-of-Jail-Free Card

  • Still working and covered by your employer? Great news! Suzie says you’ve got a Special Enrollment Period to sign up for Medicare Part B whenever you’re ready—or within eight months after you finally decide to trade your desk job for a hammock. No penalty, no problem. It’s like finding out you don’t have to attend the annual budget meeting after all!

5. What About Part D?

  • Is Your Prescription Coverage Up to Snuff? If your employer’s prescription plan is as strong as the coffee in the break room, you can skip Part D for now. But if your plan’s looking a little weak, like the decaf everyone avoids, Suzie suggests enrolling in Part D to avoid any late penalties. Nobody likes paying extra, especially when that money could be spent on something important—like more office donuts.

In Summary: If you’re still working, it’s not a one-size-fits-all when it comes to Medicare. Suzie from Wenatchee Insurance is here to help you navigate the maze of Medicare decisions without breaking a sweat. Whether you’re working for a big corporation or a small business, Suzie’s got the advice you need to keep your coverage (and your sanity) in check. After all, the only thing more confusing than Medicare is trying to figure out who took the last donut!

Talk with Suzie for Medicare

Topics: health insurance, Medicare, Medicare Advantage, Home Insurance, Car Insurance, Business Insurance, Suzie,  Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth, Quincy, Cashmere, Entiat,

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Health & Medicare

For nearly a decade we have assisted with Health & Medicare Solutions. We are proud to be selected by the Washington Healthplanfinder to be one of ten Enrollment Centers located in Washington State.

We work with all ages and charge no fees.

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