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Wenatchee, WA 98801

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Category: Medicare

Can I Switch Medicare Plans, and If So, How Often?

Posted on by Matt McColm
switch medicare during annual enrollment for Medicare advantage

Switching Medicare plans is like swapping seats at the Wenatchee Wild—you can do it, but you need to know when and where you’re allowed. Medicare gives you several chances to switch Medicare if your needs change, just like moving from the bleachers to next to the glass when the view isn’t quite right.

Suzie from Wenatchee Insurance is like a friendly usher who knows all the best seats.

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Annual Enrollment – Oct 15 through Dec 7

During the Medicare Annual Enrollment Period (AEP) from October 15 to December 7, you can switch from Original Medicare to a Medicare Advantage plan, change your Medicare Advantage plan, or sign up for a Part D prescription drug plan.

During the AEP, you want to double-check your plan (ticket) to make sure that it is in the section that you want to be. You also get the chance to change the plan on your side kind of like upgrading your tickets to make sure you’re seeing the action from the best spot.

Medicare Advantage Open Enrollment Jan 1 -March 31

If you’re enrolled in a Medicare Advantage plan and decide it’s not for you, there’s also the Medicare Advantage Open Enrollment Period from January 1 to March 31. Suzie can help you switch back to Original Medicare or find a new Medicare Advantage plan during this time.

Medicare prescription plan d talk to Suzie at Wenatchee about Inflation Reduction Act

Special Enrollment Periods like losing a plan or moving

And if life throws you a curveball, like moving to a new area or losing other insurance, Suzie can check if you qualify for a Special Enrollment Period (SEP), giving you even more flexibility to switch medicare plans.

Suzie tip: We have another blog post that has a timeline for a Medicare Advantage plan leaving Washington State.

So, whether you’re looking for a better seat or just want to see the game from a new angle, Suzie will make sure you have the perfect Medicare plan to enjoy the show.

Suzie with Wenatchee Insurance has been helping people in Washington State navigate the twists and turns of Medicare for over a decade. If you have been a long-time resident, you may have encountered her when she was a Pharmacy Technician in Wenatchee. She has people who have set appointments years in advance to do the change from healthcare to Medicare.

Suzie Appointment
insurance bundle Wenatchee insurance

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

Who do I call for Medicare Fraud

Posted on by Matt McColm

We hear about medicare fraud more than we like. Suzie and Matt have been working with health and medicare insurance for over a decade in Washington State. In addition with Shayla we make up Wenatchee Insurance. We do not work for Medicare. Here is the disclaimer:

“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.”

Every agent is required to tell you a disclaimer and you will even see them on their websites. If you don’t receive one then you know that something strange is occuring.

Medicare Fraud does occur during the annual enrollment period.

The Medicare annual enrollment period runs October 15 through December 7 every year. It allows people with Medicare Prescription plans and Medicare Advantage plans to review and change plans every year. There is a lot of activity and chaos so we want to make sure that if you encounter anything strange that you can lend a hand in prevention. Having an appointment with an agent that you know can reduce the chance of fraud from occurring.

recommend setting appointment

If you are not in our office in Wenatchee at 413 Mission Street then we are talking over the phone, it is on a recorded line. Medicare enrollments over the phone have been required for the last couple of years to be recorded. Yes, trained medicare agents record calls.

Medicare Fraud prevention tips

The Washington Office of the Insurance Commissioner has some great medicare fraud tips. The suggest checking the credentials when ever you have a question about who is selling you a medicare plan. We post copies of our licenses in our office lobby.

If you see Fraud then call 800-562-6900

When you report them. Let them know who they said they were and their phone number.

What Is Medicare, and Who Is Eligible for It?

Posted on by Matt McColm
wenatchee medicare suzie

Suzie from Wenatchee Insurance— has seen this before. She can be your guide through the trails of Medicare Mountain. Suzie’s like the friendly tour guide; she has been trained about the ins and outs of Medicare and can make the whole experience as smooth as a glass of your favorite local vintage.

OK, storytime.  You are strolling through one of the scenic vineyards near Lake Chelan sipping on a crisp glass of Riesling and enjoying the view. Life is pretty sweet, but you are getting close to 65, and suddenly, Medicare looms on the horizon like a far-off mountain range. You have had coverage for years from your job. What is this Medicare everyone’s talking about, and do you need to start climbing that mountain now?

Medicare 101

Medicare is a federal health insurance program designed primarily for people aged 65 and older, though younger folks with certain disabilities or conditions like End-Stage Renal Disease (ESRD) can also qualify. Think of Medicare as a big safety net, ensuring that as you transition into your golden years, you’re covered for hospital visits, doctor’s appointments, and other essential health services.

But wait—Medicare isn’t just one massive umbrella. It’s more like a series of cozy cabins at Mt Index’s Espresso Chalet, each with a different purpose:

  • Part A covers your hospital stays, kind of like the main lodge where you’ll spend most of your time resting and recovering.
  • Part B is your medical coverage, taking care of things like doctor visits and preventive services—think of it as your day trips around the area, keeping you in tip-top shape.
  • Part C (also known as Medicare Advantage) bundles Part A and B together with some extra perks, like dental and vision—imagine this as an all-inclusive spa package.
  • Part D is your prescription drug coverage, ensuring you have everything you need, from allergy meds to daily vitamins—like stocking up on brownies before taking a picture with Bigfoot.
chat with Suzie

Who’s Eligible for Medicare?

Now, who gets to enjoy this Medicare experience? If you’re a U.S. citizen or legal resident who’s been living in the country for at least five years and you’re about to turn 65, congratulations—you’re eligible for Medicare! That is correct not everyone can get Medicare, you have to be eligible.

But Suzie knows that life isn’t always a straight path forward. Maybe you’re still working at the local apple orchard, or perhaps you’re basking in semi-retirement, splitting your time between Wenatchee and your cabin in Conconully. If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Parts A and B when you hit 65. Keep an eye on that mailbox. Otherwise, you’ll need to sign up during your Initial Enrollment Period (IEP)—a seven-month window that starts three months before your 65th birthday and ends three months after.

Suzie’s tip: Mark your calendar! Missing this window could mean penalties down the road, like forgetting to RSVP to that big community BBQ and getting stuck at the end of the line and getting the potato salad with raisons.

Suzie Medicare Initial Enrollment, Annual Enrollment or Special Enrollment

How Suzie Makes Medicare Fun

Suzie’s got your back, ensuring you’re not just surviving the Medicare process, but thriving. Picture this: It’s a sunny day in Wenatchee, and Suzie invites you to her office for a Medicare 101 session. She’s got a spread of local snacks—cheese from Walla Walla, apples from Stemilt Growers orchards, and we will skip the wine for the moment because we want to be clear-headed.

She’ll walk you through each part of Medicare, breaking down the insurance lingo into simple, easy-to-digest bites, just like that dutch apple pie you can’t resist. Maybe you’ve heard rumors that Medicare is complicated—like trying to figure out which trail to take on a hike through the Cascades. But with Suzie, it’s more like a leisurely stroll around town, where she points out all the highlights and makes sure you don’t miss a thing.

Need help choosing between Original Medicare and Medicare Advantage? Suzie’s got you covered, like marked-up trail map that shows you the best route based on your needs. She’ll make sure you’re not paying too much, missing out on any benefits, or accidentally wandering off the beaten path into a bears den in Leavenworth.

Wrapping Up the Medicare Adventure

By the end of your chat with Suzie, Medicare will seem less like a daunting mountain and more like a gentle, rolling pasture—beautiful, manageable, and maybe even enjoyable. So, when you’re ready to start your Medicare journey, remember that Suzie from Wenatchee Insurance is there to make it as delightful as a day spent exploring the best of Eastern Washington. Cheers to that!

talk with Suzie
Home Health Medicare Car Dental Prescription insurance corndog

What are the costs associated with medicare prescription Drug Plans?

Posted on by Matt McColm
Medicare prescription plan d talk to Suzie at Wenatchee about Inflation Reduction Act

Unpacking Medicare Part D Costs: A Comical Adventure with Wenatchee Insurance

When it comes to understanding the costs of Medicare Prescription Drug Plans (Part D), it can feel like you’re opening a Walla Walla sweet onion—each layer revealing yet another hidden fee or charge. But don’t worry! Suzie & Wenatchee Insurance is here to make this journey as entertaining as a treasure hunt with a map that only partially makes sense. Let’s embark on this comical adventure together!

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The Entrance Fee: Monthly Premiums

First stop on our treasure hunt: monthly premiums. Think of this as the entry fee to the amusement park. You need it to get in, but the rides are extra.

Sample: “Imagine paying to enter the park, only to find that all the rides have separate fees. Welcome to the world of monthly premiums! Some are like the pricey but thrilling dragon roller coasters, others are more like the budget-friendly but equally fun unicorn merry-go-rounds.”

The First Clue: Annual Deductibles

Next, we encounter the annual deductible. This is the amount you pay out-of-pocket before your insurance plan starts covering costs. It’s like the troll bridge before you can access the treasure mountain.

Sample: “Picture a toll booth on your way to Treasure Island. You have to pay up before you can cross the bridge. Deductibles work the same way. Until you pay, you’re on the mainland, dreaming of buried treasure.”

insurance deductibles are important to the policy

The Treasure Map: Formularies

As we delve deeper, we find the formulary—a list of covered medications. Think of it as Big X on the treasure map. If your medication isn’t on the list, it’s like looking for treasure in the wrong place.

Sample: “Navigating the formulary is like following a pirate’s map. If your meds aren’t listed, it’s like trying to dig for gold in a child’s sandbox—frustrating. Always check the map (formulary) before setting sail.”

The Hidden Charges: Co-pays and Co-insurance

Along our adventure, we can stumble upon co-pays and co-insurance—those sneaky hidden charges that pop up when you least expect them. Co-pays are fixed amounts you pay for medications, like the fee for the funhouse. Co-insurance is a percentage of the cost, like splitting the bill for the bumper cars.

Sample: “Co-pays are like knowing the cost of the funhouse upfront—predictable and straightforward. Co-insurance, on the other hand, is like agreeing to pay a percentage of your friends’ bumper car rides—unexpected and potentially pricey.”

The Final Prize: Catastrophic Coverage

Finally, we reach the ultimate prize: catastrophic coverage. Once you’ve spent a certain amount, your costs drastically decrease. It’s like finding the buried treasure after a long, arduous journey.

Sample: “Catastrophic coverage is the X marking the spot on your treasure map. After navigating premiums, deductibles, and co-pays, you finally strike gold with lower costs and peace of mind.”

Wenatchee Insurance: Your Treasure Hunt Guide

Navigating the costs of Medicare Part D plans doesn’t have to feel like a solo quest through uncharted waters. With Suzie and Wenatchee Insurance as your trusty adventure guide, you’ll find the fastest routes, avoid the pitfalls, and maybe even have a few laughs along the way.

Whether you’re a swashbuckling adventurer or a cautious explorer, let Wenatchee Insurance help you uncover the treasures of Medicare Part D plans. Because with the right guide, the journey is just as rewarding as the destination.

talk with Suzie

What Is The Difference Between Orginal Medicare And Medicare Advantage?

Posted on by Matt McColm
Medicare Advantage Prescriptions talk to Suzie at Wenatchee Insurance

When it comes to choosing between Original Medicare and Medicare Advantage, it’s kind of like deciding between a road trip along Highway 97 or hopping on a Greyhound bus tour through Eastern Washington. Both will get you where you need to go, but the experience can be quite different.

Original Medicare, the trusty old Ford wood paneled Station wagon of the Medicare world, offers Parts A and B. It’s like cruising along the Columbia with the windows down 55 miles an hour —simple with no air conditioning. You get hospital coverage with Part A and medical insurance with Part B, but you’re pretty much on your own for extras like dental, vision, or hearing aids. (Yes, Medicare does not cover everything). And just like a road trip, if you want snacks or souvenirs (prescription drugs), you’ll have to plan ahead and get yourself a Part D plan. If you skip Plan D at the start of your Medicare trip then you may have a late enrollment penalty.  

Now, Medicare Advantage (Part C) is the private bus tour with the tinted windows. Suzie from Wenatchee Insurance can guide you through the process like your seasoned tour guide. Medicare Advantage plans are offered by private companies and bundle Parts A, B, and usually D together, plus extra perks like gym memberships (perfect for keeping fit while exploring the Cascades or checking out the local wineries). Suzie can help you pick a plan that stops at all your favorite sights, whether that’s routine checkups or specialty care.

So, whether you’re a solo adventurer or prefer the all-inclusive package, Suzie has you covered. Just give her a call, and she’ll help you figure out which route is best for your Medicare journey.

health or medicare enrollment suzie makes it easier

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

What medications are covered under medicare prescription Drug Plans?

Posted on by Matt McColm
prescriptions cost money a medicare plan d can save medicare prescription

Understanding Medicare Part D Coverage: A Hilarious Adventure with Wenatchee Insurance

Navigating which medications are covered under Medicare Prescription Drug Plans (Part D) can feel like deciphering an ancient scroll written in hieroglyphics. But fear not! Suzie & Wenatchee Insurance is here to turn this daunting task into a hilarious adventure that’s as enlightening as it is entertaining.

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The Treasure Map: The Formulary

The formulary is your treasure map, showing you which medications are covered by your plan. Each plan has its own formulary, which can vary widely. It’s like a map with X’s marking the spots where your gold (meds) is hidden.

Sample: “Imagine being a pirate with a treasure map. Each X marks a spot where your treasure (medication) is hidden. Some maps are better than others, so choose wisely!”

The X Marks the Spot: Tiers of Medications

Medications in the formulary are divided into tiers, with each tier representing different levels of cost. Think of it as a hierarchy in a medieval kingdom.

Sample: “Tier 1 is the peasant tier—affordable and plentiful. Tier 2 is the knight tier—costs a bit more but offers more benefits. Tier 3 and beyond are the noble and royal tiers—high costs for high benefits. Choose your allegiance!”

health or medicare enrollment suzie makes it easier

The Scroll: Reading the Formulary

Understanding the formulary is like reading an ancient scroll. You’ll see medication names, tiers, and restrictions like prior authorization or step therapy.

Sample: “Deciphering the formulary is like reading an ancient scroll. Some words are clear, others require a magnifying glass and a translator. But don’t worry, we’re here to help!”

The Gatekeeper: Prior Authorization

Some medications require prior authorization, meaning your doctor needs to get approval before the plan covers the medication. It’s like asking the castle gatekeeper for permission to enter.

Sample: “Prior authorization is like asking the castle gatekeeper if you can enter. Sometimes they’ll wave you through, other times they’ll demand to see your credentials (doctor’s approval).”

The Quest: Step Therapy

Step therapy is a process where you must try cheaper medications before the plan covers more expensive ones. It’s a quest where you must complete tasks to progress.

Sample: “Step therapy is like a knight’s quest. You must complete the first task (try a cheaper med) before moving on to the next challenge (getting the expensive med covered).”

The Allies: Preferred Pharmacies

Some plans have preferred pharmacies where you can get your medications at lower costs. It’s like finding friendly allies in different towns during your journey.

Sample: “Preferred pharmacies are your allies in various towns. They offer you safe haven (lower costs) and help you on your quest (managing your meds).”

The Dragon: The Donut Hole

Ah, the donut hole—the fearsome dragon guarding the treasure. It’s a coverage gap where you pay more out-of-pocket for your medications. But with the right plan, you can slay the dragon and move forward.

Sample: “The donut hole is the dragon in your story—scary and expensive. But fear not, brave knight! With Wenatchee Insurance’s guidance, you can slay the dragon and continue your quest.”

calling suzie for medicare or health insurance help

The Ultimate Prize: Catastrophic Coverage

Finally, after navigating the formulary, prior authorization, step therapy, and the donut hole, you reach catastrophic coverage. It’s the ultimate prize where your costs decrease dramatically.

Sample: “Catastrophic coverage is the Holy Grail of your quest. After facing all the challenges, you find your costs reduced and your treasure (meds) more affordable. Victory!”

Wenatchee Insurance: Your Quest Companion

Understanding which medications are covered under Medicare Prescription Plan doesn’t have to be a solo quest through treacherous lands. With Wenatchee Insurance as your trusty companion, you’ll have a guide, map, and ally to help you every step of the way.

So, if you’re ready to embark on this epic adventure, let Wenatchee Insurance lead the way. Together, we’ll turn the daunting task of understanding Part D coverage into a thrilling, victorious quest.

talk with Suzie
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How Do I avoid Late Enrollment Penalty for Medicare?

Posted on by Matt McColm
Medicare and Medicare Advantage help with suzie avoid late enrollment penalty

Avoiding Medicare late enrollment penalty is like making sure you’re not stuck in traffic on the George Sellar Bridge trying to pick up your kid at the mall—you want to plan so you don’t miss out (or have an upset kid!). The secret sauce is to sign up for Medicare on time, during your Initial Enrollment Period (IEP).

The Initial Enrollment Period is three months before your 65 Birthday, your Birth month, and then three months after your birthday. Seven months can seem like a long time but yes, we have encountered a fair number of people who have missed their IEP.

Suzie from Wenatchee Insurance is like your pocket navigator, guiding you to avoid any wrong turns. If you miss your IEP and don’t have other creditable coverage, you could face penalties when you enroll. The penalties do not go away and grow the longer you delay coverage.  

Late Enrollment Penalty Example

For example, for Part B, the late enrollment penalty is an extra 10% added to your monthly premium for each full 12-month period you were eligible for but didn’t sign up.

But here’s the fun part—Suzie trained to understand the shortcuts. Maybe you have employer coverage or are covered under a spouse’s plan? In these cases, you might qualify for a Special Enrollment Period (SEP), which is like getting a personal police escort across the bridge to make it on time.

health or medicare enrollment suzie makes it easier

Suzie can also help you figure out if delaying Medicare makes sense for your situation. Just like knowing when you can grab a coffee and when you need to get going, having Suzie’s advice will ensure you’re on time and on budget. For some people, it makes sense to start their Medicare Part A Coverage while others may want to delay their Part B.

Suzie with Wenatchee Insurance has been helping people in Washington State navigate the twists and turns of Medicare for over a decade. If you have been a long-time resident, you may have encountered her when she was a Pharmacy Technician in Wenatchee. She has people who have set appointments years in advance to do the change from healthcare to Medicare.

set appointment with Suzie
Home Health Medicare Car Dental Prescription insurance corndog

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

What Is the Medicare Annual Enrollment Period (AEP)?

Posted on by Matt McColm
Medicare Annual Enrollment Period Suzie Wenatchee

The Medicare Annual Enrollment Period (AEP) is like the annual Wenatchee Apple Blossom Festival—it’s the time when everything’s buzzing with excitement, and you have a chance to make important decisions. From October 15 to December 7, this is your window to review and make changes to your Medicare Prescription or Medicare Advantage Plan for the following year.

Picture this: you’re strolling through Memorial Park with your churro, and Suzie from Wenatchee Insurance is there with a booth set up to help you navigate your Medicare options. Maybe last year, you opted for a Medicare Advantage plan that looked great, like the shiniest red car in the Classy Chassis.  But now, you realize you need a plan with more prescription drug coverage, kind of like realizing you should’ve brought sunscreen before you went to Memorial Park for the Gyros and Funnel Cakes.

Why is the Annual Enrollment Period important?

During AEP, Suzie can help you switch plans or make tweaks to your existing coverage. Insurance Companies will update current clients by mail and release plans for the following year in October. It’s like picking out the best apples from a fresh batch—you want to make sure you’re getting the best fit for your needs.

Do not let the Medicare Annual Enrollment Period pass by like a clown in the parade—stop by Suzie’s booth (or give her a call) and make sure you’re set up for a healthy, happy year ahead.

If your plan is leaving then you may have a Special Enrollment Period.

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

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

What is the Inflation Reduction Act doing to Medicare Prescription plans?

Posted on by Matt McColm
Medicare prescription plan d talk to Suzie at Wenatchee about Inflation Reduction Act

Suzie and Matt at Wenatchee Insurance have been discussing the upcoming changes for months. We view the Inflation Reduction Act as a creator of Big Changes in Medicare Prescription coverage. We see that resources will be limited during the Annual Enrollment Period. Consumers faced with large changes in Medicare Prescription Plans and Medicare Advantage plans looking for guidance for their plan update may feel pressured to take the first plan presented instead of thorough explanations of the updates.

Have you set your appointment with Suzie?

Here’s a quick overview of how the Inflation Reduction Act (IRA) is changing Medicare:

Out-of-Pocket Spending Cap for Part D:

Beginning in 2025, the donut hole is gone. The Inflation Reduction Act introduces a $2,000 annual limit on out-of-pocket spending for Medicare Part D. This is a major difference. This maximum will protect Medicare beneficiaries from excessive drug costs and provide more predictable expenses throughout the year.

Medicare Prescription Payment Plan:

Also starting in 2025, the IRA will implement a new Medicare Prescription Payment Plan. It can be started anytime during the year. This plan allows Medicare beneficiaries to spread out their out-of-pocket costs for prescription drugs over the course of the year, instead of paying large sums all at once. This change aims to make managing drug costs more manageable for beneficiaries, especially those on fixed incomes.

For example, Farmer Fred uses Stelara for his arthritis. It retails for over $20,000 a dose on his Medicare Prescription Plan. It means that the first dose cost will stop at that out-of-pocket maximum and Farmer Fred can choose to make payments on the $2000 (out of pocket maxim remember) instead of everything up front like in previous years.

Medicare Prescription Drug Price Negotiation:

The IRA allows Medicare for the first time to negotiate prices for certain high-cost prescription drugs directly with pharmaceutical companies. The process began in 2023, with the first ten negotiated prices set to take effect in 2026.

The selected drug list for the first round of negotiation is:

Eliquis

Jardiance

Xarelto

Januvia

Farxiga

Entresto

Enbrel

Imbruvica

Stelara

Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill

The next round of fifteen drugs to be negotiated will be announced on February 1, 2025 and their new prices starting January 1, 2027.

health or medicare enrollment suzie makes it easier

Already in effect:

Capping Insulin Costs:

Starting in 2023, the IRA caps insulin costs for Medicare beneficiaries at $35 per month. This cap is expected to provide significant financial relief for those who depend on insulin to manage their diabetes.

Expanded Access to Vaccines:

The IRA ensures that all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are available to Medicare Part D beneficiaries with no cost-sharing, starting in 2023. This got vaccines like shingles to Medicare recipiants with no additional cost. The considerable list is here.

These changes reflect a significant effort to make healthcare more affordable and accessible for Medicare beneficiaries, particularly in the realm of prescription drugs.

In July the Centers for Medicare & Medicaid Services  released 2025 Medicare Part D Bid Information and Premium Stabilization Demonstration. For the Stand-alone Part D plans, they are going to provide some reassurance and work on lowering some of the forecasted costs. This stabilization has been done before. It was in the early days of the Medicare Part D plans. We will not be able to discuss the individual plan prices until October.

Suzie and Matt are recommending everyone with a Medicare Prescription Plan or a Medicare Advantage Plan with Prescriptions who want assistance double-checking plans to select an appointment now as there are millions of Americans with these plans and a limited number of people who are trained to assist.

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

Set Medicare Appointment with Suzie
Home Health Medicare Car Dental Prescription insurance corndog

Five Things Original Medicare Does Not Cover

Posted on by Matt McColm
Medicare and Medicare Advantage help with suzie
Online, Phone or in person Suzie can help.

When it comes to health insurance for seniors, Original Medicare is a popular choice. Millions of Americans select it every year. It offers coverage for many essential health services. There are some gaps in coverage for Original Medicare that you need to be aware of.

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Here are five key things that Original Medicare does not cover and some examples to help illustrate these gaps.

1. Routine Dental Care

Dental Care is one of the top requested needs. This can surprise many who planned on relying only on Medicare alone for their health insurance needs. Original Medicare does not cover routine dental care, including cleanings, gum scrapings, crowns, fillings, and dentures. Suzie has several different Dental Plans to fill in the gap.

Example:
Imagine you’re 70-year-old retiree, Mrs. Johnson. You notice some discomfort in your mouth after eating some Quincy Corn and decide to visit your dentist. After the exam, the dentist tells you a filling fell out and the pain is from a root canal you need. This painful surprise is out of pocket because Original Medicare doesn’t cover dental.

2. Vision Care

Original Medicare covers eye exams for people with diabetes and annual glaucoma tests for high-risk patients.  It does not cover routine eye exams or hardware like glasses or contact lenses. Are you sensing a trend for medical coverage from the shoulders up?

Example:
Mr. Thompson, an 68-year-old retired teacher, starts having trouble reading the Wenatchee World. He schedules an eye exam at the Vision Center at Confluence and discovers he needs an updated prescription. Mr Thompson is paying out of pocket for the exam and glasses because these are not covered by original Medicare.

3. Hearing Aids and Exams

Hearing loss is common among seniors, but Original Medicare does not cover hearing aids or the exams needed to fit them.

4. Long-Term Care

Original Medicare does cover skilled nursing facility care, but only for a limited time and under specific conditions. It doesn’t cover custodial care, which includes help with daily activities like bathing, dressing, and eating if that’s the only care you need.

Example:
Imagine you are Mrs. Rivera, 82, and living alone while your kids are living in Montana. After a fall, you find it difficult to manage daily tasks like bathing and dressing. You need long-term care to help with these activities. Unfortunately, Original Medicare does not cover this type of care. This expense is going to add up quickly.

5. Overseas Health Care

Original Medicare generally does not cover health care when you travel outside the United States. This can be a significant concern for those who love to travel or have family abroad. We had to start using a travel insurance exchange to provide options.

Example:
Mr. and Mrs. Davis, a retired couple, decide to take a dream safari to Africa. While abroad, Mrs. Davis falls ill and needs medical treatment. Since Original Medicare doesn’t cover international medical care, they face hefty medical bills, adding stress to what should have been a relaxing trip.

Insurance review are important

Getting Help with Coverage Gaps

Navigating the complexities of Medicare and understanding what it does and does not cover can be overwhelming. This is where Suzie with Wenatchee Insurance comes in. Suzie helps clients understand their Medicare options and then finds solutions to cover the gaps left by Original Medicare.

Suzie can help you explore Medicare Advantage plans, which often include additional benefits. These plans might also provide some coverage for long-term care and overseas health care. Additionally, Suzie can guide you through supplemental insurance options, known as Medigap policies, which can help cover some of the out-of-pocket costs not covered by Original Medicare.

Conclusion

Don’t let coverage gaps surprise you reach out and have a chat with Suzie today and ensure you have comprehensive health coverage for all stages of life. While Original Medicare provides valuable coverage, it’s crucial to be aware that it has limitations.

Routine dental care, vision care, hearing aids, long-term care, and overseas travel health care are significant areas where coverage gaps can occur.

By understanding these gaps and seeking assistance from professionals like Suzie at Wenatchee Insurance, you can find the right coverages to meet your needs.

talk with Suzie
health or medicare enrollment suzie makes it easier

Topics: Medicare, Original Medicare, Medicare Advantage, travel insurance, Cashmere, Wenatchee Insurance, Suzie, Enrollment, Glasses, Contacts, Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth

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