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413 N Mission St
Wenatchee, WA 98801

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Category: Health Insurance

Are my doctors in network with my health insurance?

Posted on 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.

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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:

  1. 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.
  2. 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.
  3. 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.
  4. 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

2024 Cascade Select Counties

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.

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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 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 1st through December 15th.

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:

  1. Medicare the State Health Insurance Assistance Program. These are volunteers they can explain however they cannot recommend or fill in any insurance gaps.
  2. 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
We make quotes easy

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 by Matt McColm
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.

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 15th through December 7th 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,

How much does Medicare Cost

Posted on by Matt McColm
Senior Citizen enjoying being covered by Medicare

Yes, there is a misbelief out there that Medicare is free.  A couple of times a month a person will exclaim, ‘I thought Medicare was free.’  This is a Mandela effect as a large segment of the population recalls something different than what has occurred.

appointment with Suzie

Medicare, the United States Federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD), was signed into law on July 30, 1965, by President Lyndon B. Johnson.

From its inception, Medicare was divided into two main parts:

Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. For most beneficiaries, there is no premium for Part A because they or their spouse paid Medicare taxes while working in the U.S. However, there is a deductible and copayments for some services.

Medicare Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. There is a monthly premium for Part B, which has been adjusted over the years. Beneficiaries also pay a deductible and coinsurance for many Part B services.

From the very beginning, beneficiaries of Medicare Part B have been charged premiums. Over the years, additional parts of Medicare, like Part C (Medicare Advantage) and Part D (prescription drug coverage), have been added, each with its own cost structure. So, while some parts of Medicare have free premiums based on previous tax contributions, there have always been charges associated with various components of the Medicare program since its introduction.

appointment with Suzie

It is always good to consult your local independent agent, to see what cost is associated with Medicare. There are coverages that if you miss enrollment then you can accrue a permanent penalty.

Medicare from in person assistors is a different experience than online.

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

What does a health insurance plan cover in Washington State?

Posted on by Matt McColm
Wenatchee Insurance is an inclusive insurance agency

We get a lot of questions from non-professionals seeking what their plan covers. Questions are great as prior to the Affordable Care Act Health Insurance there were a ton of problems from unjustified rate hikes, lifetime limits, and infamously pre-existing conditions. The ACA standardized health insurance.

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The Affordable Care Act (ACA) requires health insurance plans to cover 10 essential health benefits:

  1. Ambulatory Services: Outpatient care without hospital admission.
  2. Emergency Services: Care in emergency rooms.
  3. Hospitalization: Surgeries and overnight hospital stays.
  4. Maternity & Newborn Care: Care before, during, and after childbirth.
  5. Mental Health & Substance Use: Counseling and substance abuse treatments.
  6. Prescription Drugs: Medications.
  7. Rehab & Habilitation Services: Recovery therapies for injuries or conditions.
  8. Lab Services: Tests to diagnose/treat illnesses.
  9. Prevention & Wellness: Vaccinations, screenings, and chronic disease management.
  10. Pediatric Services: Dental and vision care for children.

These are the core services health plans need to cover under the ACA. A health plan will have elements of these covered to various degrees. It is important for whoever you get your plan from to walk you through the coverages.

The annual open enrollment period runs from November 1st through December 15th. Some states that run a state exchange like Washington can make a decision on extending enrollment periods. If you don’t have insurance set an appointment or call immediately so that we can see if there are any special enrollments that would speed your start date.

appointment with Suzie

We have been providing this service since the Washington Healthplanfinder Opened on October 1, 2013. We have been part of the Enrollment Center located in Wenatchee and serve the entire state. If you ever have a question about a plan do not hesitate to talk to Wenatchee Insurance or Suzie Health Solutions.

We make quotes easy

Topics: Health Insurance, Medicare, Wenatchee Insurance, Enrollment Center, Healthplanfinder, Affordable Care Act, ACA, Obamacare, Prescription Drugs, Emergency Room, Wenatchee, Washington State

Health Insurance FAQs

Posted on by admin
Suzie Appointment

Health insurance is a vital type of insurance. Without health insurance, you might not get the health care that you need. Finding the right health insurance can be difficult and having an insurance agent you trust can help. In Wenatchee, WA, our team at Wenatchee Insurance Agency is dedicated to helping get rid of the confusion surrounding health insurance and making sure all of our clients have the right coverage. 

What is an HMO?

HMO stands for Health Maintenance Organization, and it is the most restrictive type of managed care. With an HMO you usually cannot go outside the network for treatment except in the case of an extreme emergency. You must have a primary care physician who is responsible for your care and providing referrals if you need to go to a specialist. It is also usually the most affordable type of managed care. 

Should I get a high deductible policy?

Affordability is the most common reason for choosing a high deductible policy. It may also allows you to have an HSA  (healthcare savings account) which is exempt from tax in order to put aside money to pay for covered medical expenses. 

How do I make sure my doctor takes the health insurance?

The first option is to check the list of doctors who are in the plan network but if this isn’t helping you, call your doctor’s office, they should be able to help. 

Are my prescriptions covered? 

Every plan has a formulary which is a list of covered medications. They are listed in tiers; some tiers may be free, and others may have a copay and/or a deductible. You should be able to find this on the carrier website. 

Schedule A Consultation Today

Contact Wenatchee Insurance Agency in Wenatchee, WA when you need help with your health insurance needs. We are here to answer your call. 

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simple process for insurance
Wenatchee Insurance simple process

Are Health Share Ministries worth it?

Posted on by Matt McColm
Essential oils to make you feel better

We get asked about Health Share Ministries a lot being the Full Service Enrollment Center located in Wenatchee. We are going to talk about something that is not insurance.

Our first Podcast was on Health Share Ministries.

Health Share Ministries have some advantages, such as lower monthly costs and a sense of community among members who share similar beliefs. We have had companies offer us commissions to offer these plans and most have fallen short during the selection process.

Health Share Ministries have displayed some problems and limitations:

  1. Limited Coverage: Health share ministries often have more restricted coverage compared to traditional health insurance. They may not cover certain medical conditions, preventive care, or pre-existing conditions, which can leave members with significant healthcare expenses. We want our clients to have the freedom to treat all their medical conditions that can occur.
  2. Lack of Guarantees: Unlike traditional health insurance, health share ministries are not legally obligated to cover medical expenses. If you have ever gone to use something and it wasn’t there than the normal reaction is to get angry.  We don’t like angry customers. There’s no guarantee that your expenses will be shared, and coverage decisions are subject to the ministry’s guidelines.
  3. Eligibility Restrictions: To join a health share ministry, you may need to meet specific religious or ethical criteria. This can exclude individuals or families who don’t share the same beliefs. We run an inclusive office and don’t discriminate. Why would I want to have a product not suitable for more than half our neighbors?

4. Uncertain Future: Health share ministries are not as regulated or financially stable as traditional insurance companies. They may be vulnerable to financial difficulties or changes in their sharing policies, which can affect members’ coverage. We have seen several of these companies with legal action against them over the years.

5. No Consumer Protections: Health share ministries are not subject to the same state and federal regulations as health insurers. This means members have fewer protections and may have limited recourse if they encounter problems with the ministry. With insurance, we can go to the Office of Insurance and file a complaint.

6. Administrative Hassles: Members often need to handle medical billing and paperwork themselves, which can be time-consuming and challenging, especially when dealing with multiple providers and claims. Confluence Health is not known for negotiating pricing.

7. Non-Comprehensive Coverage: Health share ministries may not cover mental health services, maternity care, prescription drugs, or other essential healthcare needs that are typically covered by traditional insurance.

8. No Financial Assistance: Government subsidies or financial assistance, which are available for many with traditional health insurance through programs like the Affordable Care Act or Cascade Care, are not available for health share ministry members.

Before considering a health share ministry, it’s crucial to carefully review your policies, coverage limitations, and eligibility requirements. As the full-service Enrollment Center located in Wenatchee, we have been educating options for eleven-plus years at no cost.

When can I enroll in Health Insurance

appointment with Suzie
Insurance Bundle

Topics, Alternative Health, Wenatchee Insurance, Healthcare, Health Ministries, Financial Assistance, Enrollment Center, Cascade Care, Affordable Care Act, ACA, Confluence Health, Chelan County

What are the alternatives to health insurance in North Central Washington?

Posted on by Matt McColm
Essential Oils make you feel better

While alternatives to traditional health insurance can offer cost savings and flexibility for some individuals, they also come with their own set of challenges and potential problems. It’s crucial to be aware of these issues before considering an alternative to health insurance.

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Limited Coverage:

Many alternatives provide limited coverage compared to comprehensive health insurance plans. They may not cover pre-existing conditions, essential health benefits, or preventive care, leaving you vulnerable to unexpected medical expenses.

Lack of Regulation:

Health insurance is heavily regulated to ensure consumer protection and guarantee certain standards of care. Some alternatives, such as health-sharing ministries and discount health plans, may not be subject to the same regulatory oversight, which can lead to less transparency and potential risks.

We have seen Health Share Ministries forced to leave the state over bad behavior. Despite some offering lucrative commissions offered by some of these companies, we want coverage access to all our clients with minimal fight when they utilize the product.

Pre-Existing Conditions:

Some alternatives may exclude coverage for pre-existing conditions or impose waiting periods before covering them. This can be a significant drawback if you have chronic health issues. If it has a waiting period then it is not a qualified health plan.

Qualified health plan can have low copays.

Limited Provider Networks:

Direct Medical Providers can be on a subscription or fee basis. They have a registry, and some people use it to supplement primary care availability. However most do not have access to major care such as surgery so be aware of limitations. Lupine Family Medical is one example in Wenatchee.

Alternative plans like short-term health insurance or discount health plans may have limited provider networks. Short-term plans have severe limitations in Washington State. We utilize the flexibility of the Special Enrollment periods to enroll and disenroll people into a qualified health plan for a few months.

Potential for High Out-of-Pocket Costs:

Catastrophic plans are limited to people under 30 or with a hardship exemption and are not available in all areas of the state. They also usually have a high deductible so in many cases a Cascade Care plan

Ineligibility:

Some alternatives, like Medicaid, Medicare, or health-sharing ministries, have specific eligibility criteria. If you don’t meet these criteria, you may not be able to enroll in these programs. Read the fine print.

Risk of Non-Payment:

In the case of health-sharing ministries, there is a risk that other members may not contribute their share, leaving you responsible for your medical bills. Be aware of any program that requires you to negotiate with the provider.

Before choosing an alternative to health insurance, it’s crucial to carefully evaluate your healthcare needs, budget, and risk tolerance. Consult with a financial advisor or insurance expert to determine which option is best suited to your individual circumstances. Additionally, staying informed about changes in healthcare laws and regulations can help you make informed decisions about your coverage.

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Topics: Health Insurance, Healthcare, Molina, Apple Health, Medicare, Obamacare, Mi Seguro, Seguro de Salud, Coordinated Care, Medicare, Health share, Health Ministry, short term medical, catastrophic health, Direct Medical, Washington State, Cascade Care,

When can immigrants sign up for health insurance in Washington State?

Posted on by Matt McColm
Health Insurance regardless of immigration Status
November 1st enrollment begins.

November 1st, 2023, Immigrants are eligible to sign up for health insurance regardless of residency status. Immigrants were blocked during the creation of the ACA from purchasing health insurance and they are one of the largest uninsured groups left. This includes over 800,000 Dreamers living in the United States. If your income level is under 250% of the poverty level, then you may reduce your cost with Cascade Care Credits.

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Note when Feds update DACA then DACA could see both Cascade Care Credits and Federal Credits to lower cost.

250% of the poverty level is about $36,000 a year for a single person.

Dreamers can purchase Health Insurance

The enrollment process involves a few steps:

Gather your Information: You will need to provide information such as names, birthdates, and income of the household. If your employers offer health insurance, then you will not be eligible for this program; however other household members may be. You may also need to provide your social security numbers, but you can still apply if you do not have one. You should also bring paystubs or tax returns for proof of income.

Identity Proof Document need one from List A

or Identity Proof Document need two from list B

Apply: The application process will ask for information about you and your household, and it usually takes about 15 to 30 minutes. We recommend using an in-person assister. We have them available in Wenatchee.

Choose Your Health Plan: Washington Healthplanfinder offers many plans and ways to save. The plans you qualify for depend on your details and county. You can filter plans by premium, deductible, out-of-pocket maximum, carrier, metal level, and more.

Stay Covered!: You will want to make the first payment. The insurance company will then send your card and welcome packet about two weeks later. Each year, we have open enrollment where you review and make changes to your plans.

If you enroll from November 1st to December 15th, then your plan will start on January 1st, 2024. If you enroll from December 16th to January 15th, then your plan will start on February 1st, 2024.

If your income is under 138% of the poverty level, starting from July 2024, you will be eligible for Apple Health on a first-come, first-served basis. This is about $20,000 per year.

appointment with Suzie

July 1st, 2024,  Apple Health plans for immigrants will start.

In-person assistance is recommended due to the inability to verify identity using the Federal Hub, necessitating a manual process with documentation. We work primarily with English in Wenatchee.

This is a massive project and there are web pages like https://micasadeseguromedico.com/ and facebook pages for people to get assistance.

Topics: Health Insurance, Healthcare, Molina, Apple Health, Obamacare, Mi Seguro, Seguro de Salud, Coordinated Care, Medicare, Immigrant Healthcare, DACA, Dreamers, Washington State, Independent Insurance Agent,

MI CASA DE SEGURO MÉDICO

Posted on by Matt McColm

Hace más de 11 años, cuando Matt comenzaron a trabajar con seguros médicos, preguntamos si los ITIN se considerarían como prueba de residencia para la Ley de Atención Médica Asequible. Teníamos muchos clientes y amigos con varios niveles de documentación y nuestro objetivo era asegurarnos de que todos tuvieran seguro médico.

Nos quitaron más cuando los Dreamers fueron considerados no elegibles en 2017. Ha sido una lucha y lucha para mejorar el acceso al seguro médico para los inmigrantes.

Finalmente, el 1 de noviembre de 2023 podremos comenzar a inscribir personas independientemente de su estatus migratorio en Washington Healthplanfinder. Las tarifas aún están por determinarse y no sabemos si utilizarán un ITIN como herramienta para la solicitud. A medida que haya más información disponible, se lo haremos saber. Lo que sí sabemos.

La inscripción se realizará del 1 de noviembre al 15 de enero. Tenemos dos oficinas,

Wenatchee Insurance. Esta es la dirección de 413 N Mission Street. Tiene horario extendido. El inglés es el idioma principal que se habla y su número de teléfono es 509-295-9055.

Programe sus citas con anticipación y si necesita cambiarlas, infórmenos lo antes posible. Hay 105.000 personas que han estado esperando acceso a la atención sanitaria.

My Health Insurance Home

Over 11 years ago when Matt started working with Health Insurance we asked if would ITINs be considered as proof of residency for the Affordable Care Act. We had a lot of clients and friends with various documentation levels and our goal was to make sure that everyone had health insurance.

We had more taken away when the Dreamers were deemed ineligible in 2017. It has been a fight and struggle to improve health insurance access for immigrants.

Finally, on November 1st, 2023 we can begin enrolling people regardless of immigration status onto the Washington Healthplanfinder.  The rates are yet to be determined and we do not know if they will use an ITIN as a tool for the application. As more information becomes available, we will let you know. What we do know.

Enrollment will run from November 1st through January 15th. We have two offices,

Wenatchee Insurance . This is the 413 N Mission Street Address.  It has extended hours. English is the primary language spoken and it’s phone number is 509-295-9055

Set your appointments early and if you need to change them then let us know as soon as possible. There are 105,000 people who have been waiting for access to healthcare.

Topics: Health Insurance, Healthcare, Molina, Apple Health, Obamacare, Mi Seguro, Seguro de Salud, Coordinated Care, Medicare

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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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