Health Insurance - Blog | Wenatchee Insurance Agency

How do I get Health Insurance in Washington State during Special Enrollment?

Posted on April 24, 2024April 24, 2024 by Matt McColm

We have found over the years that filling out an application as soon as possible can get many people Health Insurance earlier than waiting for Open Enrollment. (Open Enrollment runs Nov 15 through Jan 15^th).

woman qualified for special health insurance enrollment

Suzie and Matt have been helping people with applications and answering questions for over a decade. They ran the Wenatchee Enrollment Center. They charge no fees.

chat with suzie

Special enrollment periods (SEPs) for health insurance allow people to enroll in a health insurance plan outside the usual open enrollment period. These periods are typically triggered by specific life events that involve changes in your family. Here are some common reasons you might qualify for a special enrollment period:

Annual SEPs:

Apple Health: It’s Washington State Medicaid aka “State Insurance”. It is income based. You can enroll year-round.

child qualify Apple Health Coordinated Care

American Indian/Alaska Native: If you are affiliated with a tribe then you have enrollment year-round.

Cascade Care Savings: If your income is less than 250% of the Federal Poverty level then you may be eligible. Additionally, if you are not enrolled in a Cascade Care Silver or Gold plan then you could upgrade.

Short Special Enrollments:

Change in your family status: If you get married, divorced, have a birth or adopt a child, or the death of someone on your plan.

Loss of health coverage: When you lose coverage for turning 26 from your parent’s plan. Lose coverage from an employer plan or moving from Apple Health.

Change in residence: Moving to a new county, moving to the U.S. from a foreign country, or a student moving to or from the place they attend college.

Changes in eligibility for financial help: Becoming newly eligible or ineligible for premium tax credits or having a change in eligibility for cost-sharing reductions can also trigger a SEP. (Yes, always file your taxes).

Other qualifying events: Certain events, like changes in your income that affect the coverage you qualify for, becoming a U.S. citizen, leaving jail, or AmeriCorps service.

Normally, you must provide documents of the qualifying event and apply within a certain timeframe, usually 60 days after the event. This allows you to access or change your health insurance coverage in response to changes in your life circumstances.

Summary

If you do not have health insurance then we want to work with you immediately to see if you qualify. If you need additional insurance types then Wenatchee Insurance is happy to lend a hand.

appointment with Suzie

Topics: Health, Healthcare, Applehealth, Medicare, 26, Premera, Molina, Ambetter, Dental, Suzie, Wenatchee Insurance,

How do Medicare Advantage Plans pick what areas to work in?

Posted on April 19, 2024April 19, 2024 by Matt McColm

When someone shops Medicare plans sometimes the question comes up asking why isn’t a specific plan that they saw on television or the internet is offered in Chelan or Okanogan County?

appointment with Suzie

Imagine Medicare Advantage plans are like ice cream trucks. They want to visit neighborhoods where they know people love ice cream. But, they can’t go everywhere – they have to pick and choose based on a few things:

Map Check: They look at a map and say, “Hmm, can we drive our truck easily in this county? Are there enough roads (hospitals and doctors) for us to serve ice cream (healthcare)?” It’s why you may have one plan in Chelan and not in Douglas County.
Rules of the Road: They also have to follow the traffic rules. Medicare is like the traffic police, saying, “You can drive here, but not there.”
Neighborly Advice: They think about the neighbors (that’s you!). They ask, “Do the lovely folks here like our flavor of ice cream (healthcare services)?”
Counting Coins: They check their piggy banks and see if visiting a neighborhood makes sense. No point in going if the ice cream melts (costs are too high) before they can sell it!
Competition: If there are too many ice cream trucks on the same street, it might be tough to find a good spot. They look for streets with just enough room for them.
Permission Slip: Before they start the engine, they need a permission slip from Medicare. It’s like a golden ticket to drive into your county.

So, every year, these ice cream trucks (Medicare Advantage plans) figure out which neighborhoods (counties) they’ll visit. They want to make sure they can bring you the tastiest and most affordable ice cream (healthcare) with a smile! 🍦🚚

appointment with Suzie

We do not offer every plan available in your area. Currently, we represent 16 organizations which offer 62 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

Fight inflation by changing Medigap plans outside of fall enrollment in Washington

Posted on April 5, 2024April 16, 2024 by Matt McColm

Changing Medicare Medigap plan is not restricted to the specific annual enrollment period like some other parts of Medicare (Plan D), but certain considerations and rules affect when and how you can change your plan:

Usually, in spring rates change, if you find your rates inflating then talk to Suzie and see if you can change plans in Washington State. Suzie has in person, video, or phone appointments available in Washington State.

Suzie McColm with Washington State award for new individual health and medicare insurance, Medigap

Medigap plans are standardized so price shopping can fight inflation.

Guaranteed Issue Rights: Certain situations, known as “guaranteed issue rights,” allow you to enroll or change Medigap policies without medical underwriting. You have this right during your initial enrollment period. You also have this if you are switching from a Medigap plan to a Medigap plan if you have held coverage for at least three months.

Set appointment with Suzie

Trial Rights occur when you join a Medicare Advantage Plan when you were first eligible for Medicare Part A at 65, or if you dropped a Medigap policy to join a Medicare Advantage Plan for the first time. These rights allow you to switch to a Medigap policy within the first year of joining. This is a free look that prevents buyer’s remorse.

Important Plan D Note:

Reminder your Medigap plan will not cover prescriptions. Prescription Medication is covered by a Medicare Plan D. These plans are restricted to changes that can be made during the annual enrollment period.

Setting appointment for Medicare Advantage or Medigap plan.

The Annual Enrollment Period runs from October 15 through December 7^th. Yes, it is good to review your plan every year during this annual enrollment period, so no surprises occur the following year. It is not required as you will receive documentation of changes from the insurance company, it is however highly recommended.

Set appointment for Oct 15 through Dec 7th.

Set Appointment Oct 15 through Dec 7th

Dropping a Medigap Policy: Do not just stop paying for your old plan. Take the proper steps with your advisor to have a new plan in place before the old one is dropped. This prevents coverage gaps from occurring.

Before making any changes, it’s a good idea to consult with an assistor who is trained and certified to work with Medicare. The Centers for Medicare & Medicaid Services (CMS) updates the rules every year to protect consumers.

Our Wenatchee Insurance Agency is led by Suzie McColm who has the added background of being a pharmacy technician for twenty-plus years.

We love our senior insurance customers — Why be boring, life is short.

Can my tribal affiliation affect Healthcare?

Posted on February 21, 2024April 16, 2024 by Matt McColm

If you are an American Indian or Alaska Native, then healthcare was improved by the Affordable Care Act with it’s permanent reauthorization of the Indian Health Care Improvement Act. It took Matt nearly three years to find the first person that qualified for this program.

appointment with Suzie

The Top Four:

Here are the top four ways the Affordable Care Act (ACA) benefits Native Americans:

No Cost-Sharing: Native Americans with certain income levels are exempt from co-pays and deductibles when they buy insurance through the ACA Marketplace. We like to print this out because it is radically different than most people are used to.
Special Enrollment Privileges: Native Americans can enroll in health insurance through the Marketplace any time of the year, not just during the standard open enrollment period. If you enroll before the 15^th then your plan starts on the 1^st of the following month.
Access to More Services: The ACA provides additional funding to the Indian Health Service, improving and expanding available healthcare services.
Coverage for Preventive Services: The ACA ensures coverage for various preventive services without additional costs, which is crucial for maintaining good health.

For the Affordable Care Act (ACA), proof of tribal affiliation typically involves demonstrating membership or eligibility for services from a federally recognized tribe. This can be as simple as uploading your Tribal Membership Card or Tribal Enrollment Records.

The no cost sharing plans mean your only responsibility is paying the premium. There are zero co-pays and zero-deductibles on these plans. If you run into network issues then they can be changed the following month with ease.

appointment with Suzie

Suzie and Matt assist people in understanding and enrolling in health plans without charging any fees. For six years, they ran the Enrollment Center in Wenatchee. They continue a similar effort with Wenatchee Insurance supporting more insurance products.

Topics

Topics: Tribal Health, Enrollment, Healthcare, Wenatchee Insurance, NCW Insurance, Native American, ACA, Healthplanfinder

#medicare, #health #wenatcheeinsurance #thesuzie #enrollment

Who can enroll in health insurance outside of fall’s Open Enrollment?

Posted on February 1, 2024April 16, 2024 by Matt McColm

Sometimes it helps to remember things when put to a simple rhyme. We are going to consult the Bard.

talk with Suzie

If you missed open enrollment, don’t despair,
Here’s a rhyme for situations quite rare:

When life throws a curve, like a baby’s new cry,
Or marriage bells chime under the sky,
That’s a time when you can apply.

If you move your abode, a new place to dwell,
Or lose your old coverage, as records can tell,
These events open the gate, so all can be well.

A citizenship change, a status update,
Or if Medicaid says, “Sorry, you’re late,”
These too swing wide the special enrollment fate.

But remember, my friend, in this healthcare quest,
Timing is key to getting the best,
Typically 60 days post-event, no jest!

So if life changes course, be it merry or tense,
You’ve got a chance for insurance hence,
In this rhyme, I hope, it all makes sense!

The bottom line:

If you do not have health insurance then we want to see you ASAP to see if you qualify. Special Events can also occur and you could be qualified and not even know it for a plan cheaper than you expected.

This was the first year that we could assist with insuring Washington state residents that did not have citizenship like DACA or dreamers.

We do our best to make insurance understandable and usable. Wenatchee Insurance doesn’t charge fees and answers questions throughout the year. Suzie was a pharmacy technician and is incredibly usefully.

appointment with Suzie

Topics: Chelan, Dental, Health, Independent Insurance Agency, Life, Mission, SEP, Special Enrollment Suzie, Wenatchee,

What is the Medicare Advantage Open Enrollment Period?

Posted on January 23, 2024April 16, 2024 by Matt McColm

Not the Annual Enrollment Period!

The Annual Enrollment Period (AEP) takes place every year from October 15th through December 7th. Every year Medicare Eligible people can enroll or change plans that start January 1st.

This runs January 1st through March 31st

If you are enrolled in a Medicare Advantage Plan and want to change for whatever reason. Maybe you changed during the enrollment period and the new plan isn’t working. Maybe you missed changing your Medicare Advantage Plan during the AEP.

Set Appointment with Suzie

Talk with Suzie Today

Imagine Medicare as a big, bustling supermarket of health care plans. Now, the Medicare Advantage Open Enrollment Period is like this special three-month-long festival in the supermarket, starting January 1st and ending on March 31st, where you can swap your shopping cart (your current Medicare Advantage plan) for a different one.

Switching Carts (Plans): Let’s say you’re wheeling around a cart (your current Medicare Advantage plan) and you spot another cart that looks sleeker, has better wheels (better benefits), or maybe even a built-in cup holder (extra perks). You can ditch your old cart and grab the new one! Just make sure it’s still in the Medicare Advantage aisle.
Back to Basics with a Handbasket (Original Medicare): Maybe you’re tired of pushing around these fancy carts. You miss the good old days of a simple handbasket (Original Medicare). Well, you can swap your cart for a handbasket during this festival. And if you miss having a place to put your soda (prescription drugs), you can always grab one of those trendy little clip-on cup holders (Medicare Prescription Drug Plan).
Adding a Cup Holder (Prescription Drug Plan): If you switch to your handbasket and suddenly realize, “Oh no, where will I put my soda?” (prescription drugs), you can pick up one of those nifty cup holders (join a Medicare Prescription Drug Plan) to clip onto your basket.

Remember, this festival is only for folks who already have a shopping cart (are already enrolled in a Medicare Advantage plan). If you’re still contemplating the merits of a basket or a cart (if you’re on Original Medicare), this isn’t your festival, but don’t worry, your time will come during the Annual Enrollment Period (October 15 to December 7)!

So, during this special festival, feel free to peruse the aisles, compare the carts, and make sure you’re wheeling around the one that fits your shopping list (healthcare needs) the best! Just don’t try to check out with more than one cart, or you might set off the security alarms (confuse the system)! 🛒😄

Medicare has a bunch of Enrollment Periods, from Initial Enrollment Period, General Enrollment Period, Special Enrollment Period, in addition to the Annual Enrollment Period and the Open Enrollment Period. If you have questions then let us know as we are always glad to lend a hand at Wenatchee Insurance.

Topics: Medicare Advantage, Original Medicare, Prescription Drug Plan, Open Enrollment Period, Local Insurance Broker, Wenatchee Insurance

How do I pay for my Health Insurance on the Healthplanfinder?

Posted on December 19, 2023April 19, 2024 by Matt McColm

Suzie & Matt help run the Enrollment Center in Wenatchee and they get a lot of questions. How to make a payment is a big one. This year we are seeing a bunch of new folks as Cascade Care has introduced Immigrants to the Healthplanfinder.

appointment with Suzie

During the open enrollment period the Healthplanfinder allows for an initial payment once your plan has been selected. The open enrollment period runs from November 1^st through December 15^th.

Since Washington State has it’s exchange the Washington Healthplanfinder they can add additional enrollment periods. For this year, we are going to January 15^th for plans starting February 1^st.

Some companies will not ship your insurance policy information before they have received payment so it is an important step.

Your main screen will look like this:

Go to the Payment tab, push the Green button, and process the payment. Some companies will allow you to set up the automatic monthly payment here.

Here is the payment tab.

After the enrollment period

You will want to work directly with the insurance companies. Some will allow for automated payments and some insurance companies work well with brokers to allow for payment processing. (Talk to your insurance broker if this is an option).

The current list of insurance companies and their payment links:

Ambetter from Coordinated Care

Washington Apple Health

Companion Life

If you enrolled using the Washington Healthplanfinder then you can make an immediate payment using the Washington Healthplanfinder during the enrollment period. If you want to use the insurance company’s webpage then it may take a couple of days for the files to transfer. Making a call to the insurance company can speed up the process.

appointment with Suzie

Do not hesitate if you have questions about your insurance plan on the Washington Healthplanfinder to contact Suzie and Matt.

Are my doctors in network with my health insurance?

Posted on December 10, 2023April 19, 2024 by Matt McColm

PPO or HMO how does your health plan work

At the Enrollment Center, we get asked a lot about networks from people wanting to understand their plans. There are a lot of assumptions about networks and this is intended to dispel some of those assumptions.

If you want assistance then let us know. It costs nothing to work with us.

appointment with Suzie

Domestic medical tourism refers to the practice where individuals travel within their own country to access medical treatments or healthcare services that are not available or are of a different quality or more affordable in another region or city within the United States. This can include a wide range of medical services, from major surgeries and specialized treatments to elective procedures and wellness services.

Key aspects of domestic medical tourism include:

Accessibility of Specialized Care: Patients might travel to another part of the country to access specialized medical expertise and advanced treatment options that are not available in their local area.
Avoiding Long Wait Times: In countries where healthcare systems face high demand, patients may face long wait times for certain procedures. Traveling to another region where the wait times are shorter can be an appealing option.
Combining Treatment with Leisure: Some patients might combine their medical treatment with leisure activities, turning their medical trip into a more pleasant experience. This is particularly common in areas known for their natural beauty, cultural significance, or relaxation facilities.
Quality of Care: Patients may perceive healthcare providers in certain cities or regions as being of higher quality than those available locally, prompting them to travel domestically for treatment.

Domestic medical tourism is influenced by factors such as the availability of healthcare services, the cost of care, the quality of facilities, and the reputation of medical practitioners in different regions of a country.

Domestic medical tourism has forced insurance companies to limit their networks to reduce provider costs. There has been a shift from the individual marketplace from Preferred Provider Organization (PPO) plans to Health Maintenance Organization (HMO) to Exclusive Provider Organization (EPO).

Every year during early summer, people have the right to make comments on the health plans during the public comment part of the plans.

It takes providers and insurance companies working together to build networks. Some options in Central Washington for Individual plans.

On our state’s exchange the Washington Healthplanfinder.

Want help in picking a plan? Here you go.

Coordinated Care Corporation/ Ambetter

Ambetter for 2024 Network. For a current list of network providers then please go to guide.ambetterhealth.com.

Networks in Washington State

Coordinated Care across the United States.

Community Health Plan of Washington

In Wenatchee, the most popular clinic is Columbia Valley Community Health Service (CVCH) however there are over 21 Community Health Centers operating 200 Primary Clinics and over 70 Hospitals operating in the Community Health Plan of Washington‘s network.

Family Health Centers in Okanogan and Douglas Counties

Moses Lake Community Health Center in Moses Lake

New Health in Ferry, Pend Oreille, Spokane and Stevens Counties

Yakima Neighborhood Health Services and Yakima Valley Farm Workers in Yakima

Lifewise Health Plan of Washington

Lifewise has a variety of different levels, especially pay attention to the Cascade and Cascade Select plans as not every doctor is contracted with every Lifewise Network.

One of the Big advantages to Lifewise is the exclusive access to the Kinwell Clinics located throughout Washington State.

While domestic medical tourism has played a role in reshaping the Washington State Insurance and provider networks, we do have the ability with the three plans to travel to different parts of the state and still be with in network.

Please double check coverage prior to selecting a plan and prior to medical procedures as networks can shift with contracts.

set appointment with Suzie

Topics: Healthplanfinder, Washington, Coordinated Care, Community Health, Lifewise, HMO, PPO, Medical Tourism, Hospital Networks,

Yup, civilian healthcare is a bit of a mess.

Posted on November 28, 2023April 19, 2024 by Matt McColm

Employers don’t have to offer health insurance. Some employers don’t. I have used the exchanges since I am self employed and there was a gap in coverage for my Veteran’s coverage.

appointment with Suzie

So you have people like me all over the United States helping match people with health insurance that works for their budget and their needs.

When and where to go?

The Open Enrollment Period for Healthcare is November 1^st through December 15^th.

For the United States, the main exchange is Healthcare.gov. If you have enough knowledge, then you can do it yourself or it can help you find someone to assist you.

I work in Washington state. Our state’s exchange is the Healthplanfinder.com. State Run exchanges can have extra benefits for example we get a bonus month for enrollments. My wife and I have been running one of the ten enrollment centers for the state which are located in Wenatchee. We have special rules in that we explain all of the plans on the exchange and are available year-round to assist and answer questions.

Who can help?

Check-in with your state resources and whenever possible use local resources. Health insurance plans are very regional like contracting down to the county level. There is a lot of disinformation out there as you work with more trained professionals the opportunity for understanding increases.

Just in case they need Medicare the Annual Enrollment Period is October 15th through December 7th. Yes, the overlap means that the people assisting people are incredibly busy.

Two groups that can be of further assistance:

Medicare the State Health Insurance Assistance Program. These are volunteers they can explain however they cannot recommend or fill in any insurance gaps.
National Association of Benefit and Insurance Professionals (NABIP). These are trained insurance professionals who can recommend plans and fill in protection gaps. If you local one then you are helping fund a small business.

Once you find a volunteer or broker that you connect with then do not hesitate to set an annual appointment early. Every year review your options and it will reduce surprises in the long run.

Outside of Open Enrollments, there are Special Enrollments

If you qualify for Medicaid or American Indian & Alaska Natives then you can enroll year-round. If you lose coverage or gain immigration status then you can use a special enrollment. Sometimes the state will declare a special enrollment for a disaster. Our office runs every application because special enrollments occur regularly and we want our clients to have the opportunity. If they miss it then they are set for the fall enrollment.

This year we had a large number of people setting appointments in September for their Fall appointments and they were able to spend minimal time waiting for an appointment or chasing a calendar space.

Suzie appointment

Topics: Healthcare.gov, Healthplanfinder, Health Insurance, Medicare, ACA, Medicaid, SHIP, Enrollment Period, Washington, Wenatchee, Independent Insurance Agent,

What are the benefits to Medicare?

Posted on November 4, 2023April 26, 2024 by Matt McColm

Medicare, since was signed into law on July 30, 1965, by President Lyndon B. Johnson, has had a profound impact on the health and well-being of seniors in the United States.

appointment with Suzie

Some of the major benefits include:

Improved Access to Healthcare: Prior to Medicare only a little over half aged 65 and older had some type of hospital coverage. There were numerous instances where private insurance companies were terminating health policies for aged persons in the high-risk category

Financial Protection: Before Medicare, healthcare expenses were a significant financial burden for many seniors. By providing coverage for various health services, Medicare has reduced the out-of-pocket medical expenses for seniors.

Increased Life Expectancy: Improved access to healthcare services and treatments through Medicare has contributed to increased life expectancy for seniors. We gained almost a decade of life expectancy.

Quality of Care: Over the years, Medicare has implemented various measures and initiatives aimed at improving the quality of care received by beneficiaries. By setting standards and promoting best practices, Medicare has influenced healthcare quality not just for its own beneficiaries, but for the entire U.S. healthcare system.

Shift to Preventive Care: Medicare has placed an emphasis on preventive services, offering screenings and tests at no or low cost. This not only helps in the early detection of diseases but also reduces the long-term costs of treating advanced diseases.

Support for Health Innovation: Medicare, due to its sheer size, has been at the forefront of various health policy innovations, from payment reforms to telehealth. Medicare Drug price negotiation has begun thanks to the Inflation Reduction Act.

Economic Impact: The introduction and expansion of Medicare influenced the medical profession, hospital expansions, the pharmaceutical industry, and other health-related sectors, leading to job creation and economic growth.

Improved Mental and Physical Health: Studies have shown that the establishment of Medicare was associated with improvements in the self-reported physical and mental health of older adults.

Summary

Medicare has played a crucial role in reshaping healthcare for seniors, providing them with improved access to medical services, financial protection, and better health outcomes. It’s evolved over time in response to various challenges and the changing needs of its beneficiaries. We look forward to seeing what Medicare does in the future.

It is why we recommend our clients check in at least once a year to see if any updates can benefit them. The Medicare Annual Enrollment period runs from October 15^th through December 7^th of each year.

appointment with Suzie

Medicare part A, Part B, Part C and Part D

Topics: Health Insurance, Medicare, Wenatchee Insurance, Enrollment Center, Healthplanfinder, Affordable Care Act, ACA, Obamacare, Prescription Drugs, Medicare Advantage Plan, Medigap, Health Alliance, Wenatchee, Washington State, Chelan,

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Annual SEPs:

Short Special Enrollments:

Summary

Medigap plans are standardized so price shopping can fight inflation.

Important Plan D Note:

Set appointment for Oct 15 through Dec 7th.

The Top Four:

Topics

The bottom line:

Not the Annual Enrollment Period!

This runs January 1st through March 31st

Here is the payment tab.

After the enrollment period

The current list of insurance companies and their payment links:

Key aspects of domestic medical tourism include:

On our state’s exchange the Washington Healthplanfinder.

Coordinated Care Corporation/ Ambetter

Community Health Plan of Washington

Lifewise Health Plan of Washington

When and where to go?

Who can help?

Outside of Open Enrollments, there are Special Enrollments

Some of the major benefits include:

Summary

WE return calls & are here for appointments..OR you can start your free online quote now!

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