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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

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.

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

What are the benefits to Medicare?

Insurance Bundle

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.

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 15th through December 7th of each year.

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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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.

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