Help, my Health Insurance Plan (or Medicare Plan) is leaving

Health Insurance or Medicare Plans? Suzie and Matt at Wenatchee Insurance can lend a hand.

Every year there is a risk of a Medicare or Health Insurance Plan leaving the area. We review and update plans every year. It is one of the reasons that Suzie and Matt go through training every year with Insurance Companies and the Healthplanfinder. Wenatchee Insurance is an independent insurance agency and we contract with different companies to be able to offer options.

Medicare Advantage is my Insurance Plan

You have options to make a change. The first week of October, you will receive the Medicare Annual Notification of Change (ANOC) Letter. Read the letter as it will inform you of price increases and policy changes. If you do not receive a letter then call during those first two weeks of October. Yes, we had a bunch of people ignore their letters one year only to have their Medicare Drug plan drastically increase cost have to wait until the following Annual Enrollment Period to make a change.

  1. The Medicare Annual Enrollment Period is October 15th through December 7th. This is the time period to make changes to Medicare Advantage and Medicare Drug Plans. Yes, we have had people move from a Medigap to an Advantage Plan and this is the time of year to do that.
  2. The Medicare Advantage Open Enrollment Period is January 1st – March 31st. You are allowed to make one change to a Medicare Advantage Plan during this time frame.
  3. When your plan is leaving then you get a Special Enrollment Period. (Keep a copy of your ANOC Letter)
    • You can get a new Medicare Advantage Plan from December 8th to the last Day of February.
    • You can join a new Medicare Part D Stand Alone plan and you may enroll in a Medigap (Medicare Supplement) within 63 days after your Medicare Advantage Plan ends!

We have gone through this process when Sound Path Health and Health Alliance left the area. Suzie is very good at smoothing out the differences between the old and new plans.

When ever we see a large policy shift, we recommend setting your appointment as early as possible. If you don’t see an appointment then call. We do return calls plus we do our best to expand calendars. Be sure to bring your Red, White and Blue Medicare drug and any prescriptions or Medical information that you want to be checked against your plan.

If you have a PEBB plan or another employer plan then you need to go to them for a review.

Health Insurance Dates

Health Insurance is my need.

You have a plan for under 65 then you are probably using the Washington Healthplanfinder. There are some of the lowest cost options available in the area. Matt has been working on these plans so long, he got to test the Healthplanfinder before it went live. A renewal with a connected account and no major changes can take less than 15 minutes. If you have worked with Suzie or Matt over the last two years then you probably have an account connected to them. If you don’t know then give us a call and we can double check prior to the appointment.

Matt got to assist when Premera and Molina left our area and some counties getting down to a single insurance company.

The Open Enrollment for Healthcare is November 1st to January 15th.

When you enroll November 1st to December 15th then your plan starts January 1st.

When you enroll December 16th through January 15th then you plan starts February 1st.

You will want to confirm you plan this year as there are a lot of changes occurring. If you have someone in the Household on Apple Health then you definitely want to understand the updates. If do not see a space available then call the main number. We do our best to find room.

Yes, losing your Health or Medicare plan suddenly can be a shock. Suzie and Matt have seen this hundreds of times and are well prepared for changes. If you have questions then we want to hear them including the middle of the year. We are a full service agency so if you have additional insurance needs then let us know.

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Be ready for Apple Health changes like work requirements

Apple Health Free Health insurance Washington Medicaid

Apple Health is going through a massive change because of the Big Beautiful Bill that was passed in 2025. Suzie and Matt have been lending a hand with free or low cost health insurance for years in Washington state.

Here are Apple Health changes that we will see first hand.

No longer eligible for Apple Health After September 30th, 2026

  • Asylees
  • Conditional entrants
  • Refugees
  • Individuals for who deportation or removal has been removed
  • Victims of trafficking
  • Violence Against Women Act (VAWA) self-petitioners
  • Parolees, including:
    • Individuals paroled as part of the Afghan Allies Protection Act of 2006
    • Afghans granted humanitarian parole between July 31, 2021 and September 30, 2023
    • Ukrainians granted humanitarian parole between February 24th, 2022 and September 30, 2024

Yes, over the last year the Federal Government has put into place restrictions on who is covered by Apple Health (Medicaid)

Starting October 1st, 2026, Apple health will be limited to:

  • U.S. citizens and Nationals
  • Lawful Permanent residents who have met or are exempt from the 5 year bar
  • Compact of Free Association Islanders (COFA)
  • Cuban-Haitian entrants

At Wenatchee Insurance, we do support Health and Dental Insurance regardless of Immigration status. We have have lent a hand assisting Immigrants gain health insurance for years and continue to assist with options.

January 2027 Changes to Apple Health

Yes, we will be looking at enhanced verifications in 2027, if you have an Apple Health plan as it comes up for renewal the changes will come into effect. Yes, the Healthcare Authority has shown that it will be thousands of people in our area impacted by the changes.

Starting January 1st, 2027 adults who qualify for Apple Health must meet work requirements. The exemptions are:

  • Pregnant or in 12-month postpartum period
  • Under 19
  • Foster youth or former foster youth under 26
  • American Indian/Alaska Native (AI/AN) and certain Tribal Populations
  • Parent, caretaker, or guardian of a child under 14
  • Household member of SNAP (food assistance) or TANF (cash assistance)
  • Parent, caretaker, or guardian of an individual with a disablity
  • Entitled to Medicare Part A or B
  • Incarcerated or within 90 days post release period
  • Medically Frail
  • Alcohol or substance use disorder treatment (AUD/SUD)
  • Disabled veteran with 100% total disablity
  • In a short term hardship

To meet the work requirement you must:

  • Have at least $580 in monthly income (or average $580 per month over a 6 month period)
  • Enrolls in an Educational program at least half time
  • Participates in at least 80 hours per month in a work program
  • Participates in at least 80 hours per month in community service.
  • or has a combination of 80 hours of work, community service or educational program per month average.

Yes, the verification is moving to twice a year in 2027. At Wenatchee Insurance, we assist in uploading documentation and lend a hand in understanding the enrollment. There will be at times that the client will have to call the Healthcare Authority directly for an eligibility determination or an activation of a WA Pathways policy.

At Wenatchee Insurance we have supported Apple Health without compensation since our beginning. If you have questions or need assistance then let us know and we will lend a hand.

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2027 Proposed Individual Health Insurance Rates

The Office of the Insurance Commissioner has released the proposed individual rates for 2027. A consumer can even comment about the proposals on the OIC’s Webpage. It’s a very good idea to give feedback. Last year we saw a massive jump in rates and we are seeing a repeat with the lack of positive legislation.

Proposed rates Wenatchee

If you want to make a comment then head to the OIC’s page and you can make comments on each company.

The factors are pretty important.

  1. The loss of the Enhanced Tax credits has drove the uninsured number higher which costs to providers who pass on the cost to the consumer. These impact rural families, small businesses and early retirees the most. It directly impacts millions of Americans.
  2. The Medical Loss Ratio. A individual insurance company must spend at least 80% of premiums on healthcare or they rebate the owner of the policy. There isn’t a single insurance company that was under 80%. For a successful change to occur then Provider and Pharmaceutical prices have got to be addressed.
  3. The massive loss of enrollments. A record number have disenrolled compared to last year.

These are not the final rates. The average requested rate is 22.4% and individual plans could shift very differently that the overall picture. They have to be approved by the Office of Insurance then approved by the Healthplanfinder.

There are plans that are choosing to de-commission so consumers will have fewer options for customer service. The more plans that offer fewer commissions, it makes it a challenge to keep lights on for community resources. Some agents may drop out or start charging fees. We do our best to offer additional types of insurance to fill in the gaps and allow our health agents to continue despite an Insurance company failing to compensate.

Select your appointment early.

Medicare Annual Enrollment is October 15th through December 7th

Healthcare Open Enrollment is November 1sth through December 15th.

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Where to get a 1095 form to file taxes?

1095 form as important for healthcare and we do print them at Wenatchee Insurance

Tax season is almost here and people start looking for their 1095 form. It runs from January 16th through April 15th of 2026. If you are receiving your healthcare from the Washington Healthplanfinder, you must file your taxes. It is how the Federal Government double checks if you are receiving all of the help that you are qualified for in the form of Advanced Premium Tax Credits that lower the monthly cost of insurance.

If you receive too much APTC then you will have to repay some or all the excess amount when you file your taxes.

If you receive too little APTC then it will increase your tax refund or lower the amount of taxes that you owe.

There are 3 types of 1095 form

1095-A form is made available usually in the last week of January on the Healthplanfinder and a copy is mailed out. This is for the people who were receiving tax credits that the reduce of the cost of healthcare. In our immediate area in Central Washington if you have Ambetter, Community Health (paid plan) or Lifewise then you will have one of these forms.

If you don’t have a printer and need a copy if you are a client and stop at Wenatchee Insurance on Mission Street, then we can print an additional copy for you.

1095-B form is for the people using Apple Health. It is provided by the Healthcare Authority. It is not mailed out. You can request a form directly from the Healthcare Authority’s page. Form 1095-B is not required when filing taxes.

1095-C form is from employer sponsored health insurance. It is not required for filing taxes.

The 1095-A Form is needed to fill out Form 8962 to reconcile. We saw clients in 2025 that failed to properly file this have problems with their tax credits and recommend filling on time with all forms to prevent the loss of tax credits.  

Remember you can adjust your income through the year to better reflect your income so that you don’t have to pay back excess tax credits.

Suzie and Matt have been lending a hand for 13 years in better understanding Health Insurance and if you have questions or just want someone to double check your account it is easy to add a broker of record.

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Making your payment during Open Enrollment

We help a lot of people in Washington State with their enrollment and education about health insurance. If you are using the Washington Healthplanfinder during Open Enrollment then you have a pay now button feature to get the initial payment completed. We are brokers and don’t charge fees for our work.

When you log into the desktop version. You will see a row of buttons across the top. You want the one labeled Payments.

Healthplanfinder screenshot of tool bar.

During most of the year, the payment tab will list payment options. However during Open Enrollment, the Washington Healthplanfinder will list a pay now button for most companies. When you click on the pay now button for it will create a pop up which goes to a secure payment site for the company.

This first payment is important as it secures the insurance policy. Most companies wil then send the policy’s insurance cards and information booklet after this payment has been made. A few of the companies will allow you to schedule monthly payments using the popup while others you will have to set up with them at a later time. The booklets and cards usually arrive about two weeks after the payment.

At Wenatchee Insurance Agency, Matt and Suzie have been lending a hand to our community for over 13 years with Health Insurance. While our agency does a whole lot more, we get asked a lot of questions regarding Health because it is complicated.

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Washington State and the new Prior Authorizations for Medicare

Prior authorizations in Washington state for original medicare

Beginning January 1st, 2026 some medical procedures under traditional Medicare will require Prior Authorization in six states before performing the service. Yes, Washington state has been selected. Arizona, New Jersey, Ohio, Oklahoma, and Texas.

This updates individuals with Medigap plans such as Plan G or Plan N, if they are using traditional Medicare coverages. While common in health plans and Medicare Advantage Plans these are new for original Medicare.

This change is part of a trial program called WISeR (Wasteful and Inappropriate Services Reduction). It is designed to curb medical overuse and detect potential fraud.

What Procedures will require a Prior Authorization?

There were 17 types of procedures that were flagged to now need approval. Here is what made the list.

  • Facet joint procedures for back pain
  • Nerve and muscle tests (electrodiagnostic testing)
  • TENS units and similar electrical stimulation devices
  • Hyperbaric oxygen therapy
  • Spinal cord stimulators
  • Deep brain stimulation (commonly for Parkinson’s)
  • Sacral neuromodulation (for urinary conditions)
  • Transcatheter aortic valve replacement (TAVR)
  • Arthroscopic knee cleaning or debridement
  • Vertebroplasty/kyphoplasty for spine fractures
  • Epidural steroid injections
  • Non-emergency ambulance transport
  • Botox injections for medical issues
  • Negative pressure wound therapy pumps
  • Hernia repairs
  • Lumbar spinal fusion
  • Skin graft substitutes for chronic wounds

Physicians will be required to submit documentation before the service is performed. If approval is not granted, coverage can be denied requiring the patient to pay out of pocket.

Who made this decision for Prior Authorization?

This was a rules change with the Centers for Medicare & Medicaid Services (CMS), Department of Health and Huma Services. Every administration picks there team to implement programs that they feel will have the biggest impact for consumers. They did a press release in June regarding this matter and it is estimating that they spent 25% of healthcare on services that had little to no clinical benefit. HHS Secretary Kennedy, CMS Administrator OZ pledge to fix Prior Authorization system.

At Wenatchee Insurance we do our best to lend a hand in understanding and enrolling in Medicare and insurance Programs. We are an independent insurance agency. If you are looking at supplemental policies then let us know and there are enrollment periods.

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How does TrumpRX work and can it save me money?

How does TrumpRX work

OK, Tariffs are playing an important role in what the administration is doing with drug pricing. TrumpRX appears to be using them to inflate the price on medication for companies that don’t participate with the administration. 

Trump is imposing a 100% Tariffs. Effective October 1st, 2025 if a company reaches an agreement with the Administration then they will be immune to them. There is the common consensus that everyone participating in this deal will have customers paying inflated costs due to the tariffs. 

Companies working with TrumpRX

  Pfizer is one of the first companies to reach an agreement. They are one of the largest drug companies and Eliquis, Ibrance and the Covid vaccine are among the drugs that they manufacture. Eliquis was one of the drugs with the Medicare Negotiated price for 2026.  Ibrance was selected for the Inflation Reduction Acts Medicare negotiated price for 2027. So thanks to the Inflation Reduction Act from the Biden administration, 

It also sounds like Novo Nordisk and Bristol Myers Squibb have also signaled participation. 

They will be doing a Direct to Consumer Model with a yet to be launched website. There is a marked page at TrumpRX.com but it is not functional as of publishing this blog. 

It could be very similar in the direct to consumer model of AmericasMedicines.com  from a Pharmaceutical trade group PhRMA where people can go directly to the manufacturers. 

It sounds like a stepped up version of Mark Cuban’s CostPlus. Where they have a few drugs that they ship directly to the consumer. 

Only time will tell if it has more savings than GoodRX. 

Health Insurance Dates

Important Dates for Medicare and Health

Medicare Advantage and Prescription plans can be enrolled or changed October 15 through December 7th. 

Healthcare Plans can be enrolled or changed November 1st through December 15th. 

For Washington State select an appointment at the Wenatchee Insurance Agency. 

Wenatchee Insurance Agency is an independent insurance agency. 

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Health Insurance and Your Privacy Rights

Privacy is important to Matt and Suzie at Wenatchee Insurance

Maintaining your health can be a challenge, and paying for healthcare costs can make that challenge even harder. If you don’t get health insurance through your job, purchasing private health insurance can make a big difference to your budget. Privacy plays an important role. If you are in the Wenatchee, WA area, our team at Wenatchee Insurance Agency would like the opportunity to explain the benefits of health insurance.

Health Insurance and Your Privacy Rights

Today’s increases in technology use have brought many advantages, but they have also created opportunities for unauthorized access to personal information. Your health status and healthcare information are very personal. When you visit a healthcare provider, you don’t want to worry about whether your diagnosis, treatment, and medication information will be shared with anyone except the companies that need that information to work with you.

According to the Washington Office of the Insurance Commissioner, you have a right to privacy when it comes to your healthcare information. This means that your personal information can be shared only with sources that need to provide service to you. The same website assures you that you can have sole access to your healthcare information. Privacy is especially important for clients under the age of 18 who are legally entitled to consent to healthcare procedures, including procedures related to their reproductive rights.

Call Us for an Appointment Today

You never know when you’ll need an emergency medical procedure. Our team at Wenatchee Insurance Agency can help you find a policy that fits your needs and budget. Clients in the Wenatchee, WA area have discovered that our team is knowledgeable and provides consistently excellent customer service. Call us for an appointment today, and let’s work together to find the right insurance policy for you.

 

 

Please note during the Fall Enrollment Periods.

Medicare Annual Enrollment Period is October 15 through December 7.

Healthcare Open Enrollment Period is November 1 through December 15 (for plans starting January 1).

There are only so many hours in the day. Please select an appointment as early as possible or give us a call.

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Apple Health Dental changes can be scary if you don’t know.

Apple Health or medicaid is free health insurance

Yes there has been a big change to Apple Health in regards to Dental Care. Yes, we write a lot of dental Insurance at Wenatchee Insurance. As part of the budget the Adult and children’s Apple Health (Medicaid) dental rates are being reduced effective July 1st, 2025.

In our area we have a select few dentists and orthodontists that accept Apple Health. When our son needed braces, every six weeks we would make the drive from Wenatchee to Ellensburg so that he would have his teeth worked on. It took a lot of coordination between his pediatric dentist and the orthodontist to get the approval.

Where to find Apple Health Dental care?

OK, have you been to the Dentist Link Set up by the Healthcare Authority? It provides an excellent search tool to find a dentist accepting Apple Health Dental in your area. You can also call or test a referral specialist 844-888-5465 from 8 am to 4:30 pm on weekdays.

Adult Apple Health covers a lot of different things.

What does Apple Health Dental cover for adults?

If you have Apple Health as an adult it covers more than people think. Yes, it really does take care of fillings, front teeth root canals and dentures. There are some things that it doesn’t cover by it’s self like Dental Implants and Adult Orthodontics.

How do I enroll?

Suzie and Matt have been assisting people enroll for over a decade into Apple Health plans. We have never charged a fee and do not get paid for enrolling people in these plans. We do it because people in our community use healthcare and it is expensive to go without. There are no enrollment periods with Apple Health and it is based on our income level.

Children have expanded access to Apple Health using the Children’s Health Insurance Program (CHIP). Some will be zero cost or there will be a $20 or $30 monthly charge per child fee. We have a lot of families where the parents are on a paid health plan and the kids are on Apple Health. The important thing is that the family is being covered.

What happens if I am no longer eligible for Apple Health Dental

We have the conversation. We have access to several dental plans that a person can enroll year round. Some with waiting periods and some without. We even have plan that can assist adults with getting braces after a waiting period at Wenatchee Insurance. We make it as easy as possible to review your options.

Enrollment Periods

There are times when it get’s incredibly busy for healthcare so you may have to wait a little bit longer in the Fall.

For Medicare the Annual Enrollment Period for Medicare Drug Plans and Medicare Advantage plans is October 15th through December 7th.

For Medicare’s Initial Enrollment it is three months before you turn 65, the month of your birthday and three months after.

For Healthcare the Open Enrollment Period is November 1st through December 15th. (some states may have an extension so do not hesitate to ask).

Yes, people set appointments early in the year for fall appointments to insure that they are able to have a conversation about the changes to their health plan.

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Do I need to file my taxes for my Healthplanfinder insurance policy?

1095 form wenatchee insurance health
for Healthplanfinder
Healthplanfinder does send out 1095 forms for taxes

If you pay for your health insurance on the Washington Healthplanfinder then you must file your taxes every year. It is an IRS rule. Yes, regardless of your income level, you will always want to file your taxes. If your Uncle Fred says that you do not need to then look at what Uncle Sam has to say about the IRS rule.

During the first couple of weeks of the year a copy of a Form 1095-A is mailed out. If you can not find a your copy then let us know. Since the second year, we have been printing and email copies to our customers at no charge so that they could file their taxes.

(If you have Apple Health then you could receive a Form 1095-B. This form is not required to file your taxes and you can request a new copy from the Healthcare Authority. )

When you file your taxes, you take the information from your 1095-A and reconcile it using the IRS Form 8962. It involves comparing the amount of premium tax credits used with the eligible amount, based on final annual income. This is why you want your income on the Washington Healthplanfinder as accurate as possible and you can updated it during the year if your income changes.

The Advanced Premium Tax Credits are what is used to lower your monthly cost of health insurance. It is an advance so if you underestimate your income then you will be asked to pay back the portion that was advanced to you. The reverse is true if you over-estimate your income while you will pay more monthly for health insurance then you will also be paid back any unused tax credits.

Some reasons you could lose the Advanced Premium Tax Credits because:

  1. You did not file taxes and reconcile tax credits from previous years.
  2. Did not consent on application for the Washington Healthplanfinder to request updated tax information.
  3. Customers who are married filing single instead of jointly on their tax return.

If you lose the Advanced Premium Tax Credits then suddenly what you are required to pay for health insurance can increase!

You could receive a letter you don’t understand otherwise known as the scary letter that looks like this:

If you get a scary letter an want help then give Suzie or Matt a call at Wenatchee Insurance. We can confirm what the situation is and how to correct it. This is insurance so it does take times to make changes and it is one of the reasons that we recommend filing taxes as early as possible to reduce problems with your advanced premium tax credits.

Open Enrollment for the Washington Healthplanfinder is November 1 through December 15.

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