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413 N Mission St
Wenatchee, WA 98801

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Have you looked at Medicare C or Medicare Advantage?

There is original Medicare Part A (hospital) and Part B (medical insurance). Do you know about Medicare Part C or Medicare Advantage? It is another way for people eligible for Medicare to receive their healthcare coverage. They are not for everybody however they make up about half the Medicare Enrollments.

assistance in understanding and enrolling with Medicare with Suzie

 They are plans offered by private insurance companies approved by Medicare. These plans are not available in every county of Washington state. Every year, we undergo rigorous training by the Centers for Medicare & Medicaid Services and the insurance companies to understand the rules better. They are required by law to cover all medically necessary services that original medicare covers.

One way to look at it is the original Medicare is a General Contractor. The Medicare Advantage company acts like a subcontractor. When you select one of those MA plans original Medicare moves to the background and the Medicare Advantage plan takes care of the healthcare instead.

Here are some key points about Medicare Part C:

Comprehensive Coverage: Medicare Advantage plans typically bundle Part A, Part B, and often Part D (prescription drug) coverages. They may also offer additional benefits not covered by Original Medicare, such as hearing, vision, and dental.

Network Restrictions: These plans usually have network restrictions, meaning you may need to use healthcare providers who are part of the plan’s network. These are often Health Maintenance Organizations or HMO networks. Some plans also have Point of Service plans which benefit clients who travel. Reviewing networks is an important part of the Annual Enrollment Period!

Out-of-Pocket Costs: While Medicare Advantage plans can have lower premium costs, they may have different out-of-pocket costs compared to Original Medicare. They usually have co-pays for services like a traditional healthcare plan.

Additional Benefits: Many plans offer extras such as gym memberships or fitness clubs, transportation to medical appointments, and wellness programs. These are incentives or perks on top of the medical coverage that can be very attractive to clients.

Annual Enrollment: Beneficiaries can choose or switch Medicare Advantage plans during the annual enrollment periods.

From October 1st to October 14th is the review period where you can see the changes for the upcoming enrollment year.

October 15th through December 7th is the Annual Enrollment Period. This allows you to review and make changes to your Medicare plans.

Medicare Advantage plans vary greatly in terms of costs, benefits, and restrictions, so clients should compare different plans to find one that best meets their health needs.

Suzie McColm at Wenatchee Insurance has been assisting people to understand and select plans for over ten years. She also has held a pharmacy technician’s license for over twenty years which is valuable in understanding the prescription side of coverage.

simple process for insurance
Wenatchee Insurance simple process

Is a PPO or a HDHP insurance plan better?

Suzie Health and Medicare Enrollment In person assistors

When going through the interwebs, I saw the question of someone asking what people ‘prefer a PPO or an HDHP when it came to a health insurance plan from work’.  While they are using the alphabet it is looking at different attributes of a health plan in a chocolate cake with apple pie comparison.

When choosing between a Preferred Provider Organization (PPO) and a High Deductible Health Plan (HDHP), it’s helpful to consider advice from experts like those at Wenatchee Insurance Agency. Here’s what you might hear from them, along with some examples to make it clearer:

Preferred Provider Organization (PPO)

Flexibility: PPO plans are great if you want the freedom to select a doctor that accepts insurance.  For instance, if you have a preferred pediatrician at Confluence, a Cardiologist at Samaritan, and another specialist in Spokane, this plan might be best because you can visit them without needing a referral.

Costs: Wenatchee Insurance Agency might point out that while PPOs have higher monthly costs, they cover more from the start. With the wide networks, look to see if they have co-pays that occur before deductible.

High Deductible Health Plan (HDHP)

In the old days, we called these MEC plans or Minimum Essential Coverage. These were designed to cheaply cover the ten essential coverages that every plan was required to have to avoid paying a tax penalty. The tax penalty went away on the Federal level in 2019.

Saving Money: If you’re looking to save on monthly premiums and you don’t often need medical care, an HDHP could be a better choice. For example, if you’re generally healthy and mainly need coverage in case of emergencies, the lower monthly cost could benefit you.

You take the difference between the money you would spend on an expensive plan and putting it into a savings account for later.

Health Savings Account (HSA): Wenatchee Insurance Agency would also highlight the advantage of an HSA with an HDHP if it qualifies. This is a way to save money tax-free for health expenses. Say you put $50 into your HSA each month; this money can be used for medical expenses. Some of these accounts have investment options like a 401K.

Practical Examples

Example 1: Imagine a family where one member has a chronic condition requiring multiple specialist visits. A PPO might be better for them because it reduces the hassle of getting referrals and handles more costs upfront.

Example 2: Consider a young, single person who rarely goes to the doctor. An HDHP with lower monthly payments and an HSA might be more cost-effective. This person can save money in an HSA for future needs while enjoying lower premiums.

Advice from Wenatchee Insurance Agency

Wenatchee Insurance Agency would advise looking at your current health needs and financial situation. If your family has ongoing medical needs or prefers the flexibility of seeing various specialists without barriers, a PPO might be the way to go. However, if your primary concern is budget and you are in good health, an HDHP could be more appropriate.

In summary, choosing between a PPO and an HDHP involves balancing your health care needs with your financial capabilities. Wenatchee Insurance Agency suggests that by understanding these differences and considering your personal circumstances, you can make a choice that best suits your needs and budget.

Reviewing and reading insurance plans is critical. Having an adviser that you trust is an important step.

Insurance Bundle

Help, My Job’s Health Insurance Is Too Expensive For My Family

Family Health Insurance

You probably haven’t heard about the “family glitch”. The “family glitch” is an old rule in the Affordable Care Act (ACA) makes health insurance too expensive. It was impacting about 5 million of Americans and made a lot of people mad.

Here’s how it worked: The ACA said that big employers have to offer health insurance that’s affordable for their full-time workers and their families.

But when it calculates affordability, they only look  at the cost for the worker, not the entire family. (This was 8.39% of the employee’s income for 2024.)

It was frustrating because it made getting health insurance hard.

Health Insurance Rule Change

This “family glitch” was impacting millions of American and was fixed by an IRS rules change. It is why a person now needs to know the lowest cost to cover the employee and the lowest cost to cover the entire family.

If an employer now offers a plan that is unaffordable, for the family then the family members can get their health insurance with the marketplace and be eligible for advanced premium tax credits to lower their monthly cost of insurance.

The employee has access to affordable health insurance from their employer and the family has affordable insurance on the marketplace. It’s a win/win.

Free help understanding Health Insurance

Not everyone knows about this important change in health insurance and this is why Suzie and Matt like to go over applications as minor adjustments can mean the difference between having coverage and not. They ran the Enrollment Center in Wenatchee assisting people for years understanding and enrolling into insurance plans without charging fees.

Wenatchee Insurance is an independent agency that does not charge fees and have extensive experience working with the Washington Healthplanfinder, Apple Health and Medicare to provide usable options for our clients.

Insurance Bundle

Topics: WenatcheeInsurance, Enrollment, Suzie, Premera, Molina, Kaiser, Chelan, Ambetter, AppleHealth, Suzie, Washington, Healthplanfinder,

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

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 15th).

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.

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.

man lost health insurance needing help

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.

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

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

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?

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:

  1. 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.
  2. 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.”
  3. 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)?”
  4. 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!
  5. 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.
  6. 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! 🍦🚚

Insurance Bundle

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

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.

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 7th. 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.

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?

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.

The Top Four:

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

  1. 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.
  2. 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 15th then your plan starts on the 1st of the following month.
  3. Access to More Services: The ACA provides additional funding to the Indian Health Service, improving and expanding available healthcare services.
  4. 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.

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?

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

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.

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

What is the Medicare Advantage Open Enrollment Period?

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.

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.

  1. 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.
  2. 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).
  3. 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?

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.

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 1st through December 15th.

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

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

BridgeSpan

Community Healthplan

Delta Dental

Dentegra

Kaiser Permanente

Lifewise

Molina

Pacific Source

Premera

Regence

United Healthcare

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.

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

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

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

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Suzie Health Solutions

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.

Health & Medicare

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