Health Insurance

What Are the Different Parts of Medicare?

Posted on by Matt McColm

Hello again, fabulous followers of Wenatchee Insurance’s Medicare blog! Today, we’re diving into the alphabet soup that is Medicare. Grab your spoons, and let’s ladle out some knowledge on the different parts of Medicare: A, B, C, and D!

chat with Suzie

Part A: The Medicare Foundation

Let’s start with Part A, also known as Hospital Insurance. Picture it as the bedrock of your Medicare coverage. It helps cover:

  • Inpatient hospital stays: If you’re admitted to the hospital, Part A swoops in to help with the costs.
  • Skilled nursing facility care: After a hospital stay, you might need some time in a skilled nursing facility to recover. Part A has your back.
  • Hospice care: For those with terminal illnesses, Part A ensures you receive compassionate end-of-life care.
  • Home health care: If you need health services at home, Part A can help cover those too.

Example Time!

Imagine Grandpa Joe, who had a nasty fall while trying to fix the roof (don’t ask why). He ends up in the hospital for a week and then spends another month in a skilled nursing facility to regain his strength. Part A helps cover these costs, giving Grandpa Joe peace of mind and more time to perfect his roof-fixing skills (hopefully from the ground this time).

Part B: The Everyday Medicare Hero

Next up is Part B, or Medical Insurance. This is your go-to for everyday health care needs. It covers:

  • Doctor visits: Routine check-ups, specialists, and outpatient care.
  • Preventive services: Vaccinations, screenings, and annual wellness visits to keep you in tip-top shape.
  • Durable medical equipment: Things like wheelchairs, walkers, and other equipment you might need.
  • Mental health care: Outpatient mental health services.

Example Time!

Take Aunt Clara. She’s a sprightly 70-year-old who loves gardening. She visits her doctor for regular check-ups and gets her flu shot every year. Part B helps cover these visits, ensuring Aunt Clara stays healthy enough to grow those prize-winning roses.

Part C: The All-In-One Plan

Part C is also known as Medicare Advantage. These plans are offered by private companies and bundle together Part A and Part B, often with additional benefits. Some even include:

  • Prescription drug coverage (Part D)
  • Vision, dental, and hearing services
  • Wellness programs

Example Time!

Consider Cousin Sally, who prefers simplicity. She opts for a Medicare Advantage plan that includes prescription drug coverage and vision care. Now she doesn’t need separate plans for her glasses and medications – it’s all in one neat package.

Part D: The Rx Solution

Finally, we have Part D, the prescription drug coverage. This helps cover the cost of medications, ensuring you don’t break the bank when picking up your prescriptions.

Example Time!

Let’s look at Uncle Bob, who has a daily regimen of medications for his blood pressure and cholesterol. Part D helps cover the cost of these prescriptions, allowing Uncle Bob to focus on his favorite hobby – fishing – without worrying about his medication bills.

Wenatchee Insurance to the Rescue!

At Wenatchee Insurance, Suzie understands that Medicare can feel like a jigsaw puzzle with a few pieces missing. But fear not! We’re here to help you fit all the pieces together seamlessly. Whether it’s explaining the different parts or assisting with enrollment, we’ve got your back.

Remember, understanding Medicare doesn’t have to be a daunting task. With Wenatchee Insurance guiding you, you’ll be navigating the Medicare maze like a pro. Stay tuned for more tips, tricks, and delightful Medicare insights!

chat with Suzie

Topics: Medicare, Medicare Advantage, Suzie, Wenatchee Insurance, SSDI, ESRD, Hospital Insurance, Prescription Drug Coverage, Part D, Medical Insurance,

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Managing Medicare Supplement Costs with Suzie and Wenatchee Insurance

Posted on by Matt McColm

Mary, concerned about out-of-pocket costs not covered by Medicare, was exploring Medicare Supplement Insurance (Medigap) plans. She needed help understanding the costs and benefits of these plans. Mary sought advice from Suzie at Wenatchee Insurance.

talk with Suzie

The Role of Medigap Plans

Medigap plans help cover costs like copayments, coinsurance, and deductibles that Original Medicare does not cover. Plan G is among the most popular Medigap plans, offering extensive coverage but varying in premium costs by state.

Mary’s Consultation

Mary met with a Suzie at Wenatchee Insurance who explained the different Medigap plans and their costs. They reviewed the benefits of Plan G and other available options, taking into account Mary’s healthcare needs and budget.

Making an Informed Medigap Plan choice

With detailed information from Wenatchee Insurance, Mary chose a Medigap Plan G that provided comprehensive coverage at a reasonable premium. The agent also helped her understand how to manage her monthly premiums effectively.

Mary felt confident in her decision, knowing she had chosen a plan that would protect her from high out-of-pocket expenses, all thanks to the expert guidance from Wenatchee Insurance.

Medicare Supplement plan can be selected year round

When the Medicare Supplement plan increased in cost, Mary was able to talk with Suzie and switch to a lower priced plan. This would reduce inflation for years to come.

Along with the Medigap Plan

Mary selected a Medicare Plan D to cover prescriptions. While she didn’t have many prescriptions now, this prevented a late enrollment penalty and could be changed during the Annual Open Enrollment Period (October 15th through December 7th).

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We love our senior insurance customers
Why be boring, life is short.
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Who is eligible for Medicare and what is it?

Posted on by Matt McColm
original medicare, medicare advantage and part d

Hello, wonderful readers of Wenatchee Insurance’s Medicare blog! Today, we’re tackling a question that buzzes around like a rogue mosquito at a cook out: “What is Medicare, and who is eligible?” If Medicare were a party, who’s on the guest list? Let’s get to it!

Medicare: The Party Planner for Your Health

Medicare is a federal health insurance program that throws open its doors primarily to those aged 65 and older. Think of it as an exclusive club for seasoned citizens! But wait, there’s more – younger folks with certain disabilities or those with End-Stage Renal Disease (ESRD) also get a VIP pass.

talk with Suzie

How Do I Get on the List?

To be eligible for Medicare, you generally need to be:

65 or older: Congratulations! You’ve reached the golden age and earned your ticket to the Medicare party.

Under 65 with a disability: If you’ve been receiving Social Security Disability Insurance (SSDI) for 24 months, Medicare raises the velvet rope and  says, “Come on in!”

Any age with ESRD: If you’re dealing with permanent kidney failure and need dialysis or a transplant, Medicare rolls out the red carpet.

Example Time!

Imagine dear old Aunt Martha. She’s just turned 65, loves knitting, and dancing at family weddings. She’s eligible for Medicare because of her age. Now, let’s talk about Cousin Bob. He’s only 45 but has been on SSDI for over two years due to a serious accident. Medicare welcomes him with open arms too!

The ABCs and Ds of Medicare

Medicare has two parts, and then some additional toppings:

Original Medicare

Part A (Hospital Insurance): Covers hospital stays, skilled nursing facility care, and some home health care. It’s like the comfy bed you get to rest in.

Part B (Medical Insurance): Covers doctor visits, outpatient care, and preventive services. Think of it as your day-to-day health care needs.

Medicare Toppings

Part C (Medicare Advantage): These are plans offered by private companies that include Part A and B, and often Part D, plus extra benefits. It’s like getting a combo meal with a little extra sauce.

Part D (Prescription Drug Coverage): Helps cover the cost of prescription drugs. Because nobody likes an unexpected bill for their medications!

health or medicare enrollment suzie makes it easier

How Do I Sign Up?

Signing up for original Medicare is as easy as pie, and Wenatchee Insurance is here to guide you every step of the way! You can enroll:

If you have questions and want to look at toppings, then you want to ask Suzie.

Final Thoughts

Whether you’re as spry as Aunt Martha or managing health issues like Cousin Bob, Medicare is designed to help. At Wenatchee Insurance, we’re your trusted advisors, ready to answer all your questions and make the process as smooth as the chicken dance at a wedding. Stay tuned for more Medicare tips and tricks!

Remember, folks, navigating Medicare doesn’t have to be like figuring out Aunt Martha’s Blue Ribbon Cherry Pie recipe. With Wenatchee Insurance by your side, you’ll be saying, “Medicare? Nailed it!” in no time.

talk with Suzie

Topics: Medicare, Medicare Advantage, Suzie, Wenatchee Insurance, SSDI, ESRD, Hospital Insurance, Prescription Drug Coverage, Part D, Medical Insurance,

assistance in understanding and enrolling with Medicare with Suzie
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Saving on Medicare Costs with Suzie and Wenatchee Insurance

Posted on by Matt McColm

Mary was living on a fixed income and was worried about rising Medical costs despite having Medicare. She had heard about Medicare Savings Programs but wasn’t sure if she qualified or how to apply. Mary turned to Suzie at Wenatchee Insurance for guidance.

talk with Suzie

What are Medicare Savings Programs?

Medicare Savings Programs help pay for Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments for individuals with limited income and resources. Programs like the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) are designed to offer financial relief.

Mary’s Journey

At Wenatchee Insurance, Mary met with an Suzie who explained the eligibility criteria for these programs. Together, they reviewed her income and resources, and the agent helped her complete the necessary applications.

Achieving Financial Relief

Mary qualified for the QMB program, which helped pay for Medicare premiums and significantly reduced her out-of-pocket costs for medical services. She also received extra help with prescription drug costs, easing her financial burden.

Mary could sign up for a Medicare Savings Program (MSP) at any time during the year; there is no specific enrollment period for these programs. Here’s what you need to know:

  1. Eligibility Requirements: To qualify, you must meet income and resource limits set by your state. These limits may vary, but generally, your income must be below a certain threshold, and you must have limited financial resources​.
  2. Application Process: Applications for Medicare Savings Programs are handled by your state’s Medicaid office. You can apply at any time, and your state will determine which program you qualify for based on your income and resource information​.
  3. Medicare Plan Selection: Once the Medicaid Office has processed the application, then any Medicare Plan adjustments could be made.

Thanks to Wenatchee Insurance, Mary was able to understand the complexities of Medicare Savings Programs and secure the assistance she needed.

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Medicare, Medigap, Advantage, and Prescription Plan D in Wenatchee
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How much does Health Insurance cost in Washington State?

Posted on by Matt McColm

The cost of health insurance in Washington state varies depending on the plan tier, the insurer, the individual’s age and the household income level (if you want a subsidy to lower your cost).

Suzie and Matt have been educating and enrolling people in Health Insurance since the beginning of the Affordable Care Act and ran the Enrollment Center in Wenatchee for about six years. They have never added a fee and have added products along the way to assist our clients’ insurance needs.

Suzie Appointment

Here are important key points for 2024:

  • Average Costs by Plan Tier before subsidies:
  • Bronze Plans: Around $462 per month.
  • Silver Plans: Approximately $584 per month.
  • Gold Plans: About $641 per month​.
Suzie Mccolm health and Medicare Insurance Wenatchee
4th in state for new medical business

Cheapest Health Insurance Plans:

The cheapest Silver plan is the Community Health Plan of Washington Cascade Select Silver, costing around $394 per month​.

For Bronze plans, the most affordable option is Ambetter Essential Care 1 at $282 per month​.

Factors Influencing Costs:

Age is a significant factor. For example, a 60-year-old will pay about 85% more than a 40-year-old for the same coverage​

Location within Washington can also affect premiums due to regional cost differences​. We work throughout the state thanks to video conferencing and a phone system.  There are differences between King County  and Chelan / Douglas counties.

Premium Increases:

We went into detail in May that individual plans have put in rate increases for 2025. Thirteen insurance companies requested an average 11.3% increase. Now is your time to review and comment with the state.

Health insurance premiums have increased by around 7% from 2023 to 2024 across all plan tiers​.

appointment with Suzie

For personalized quotes, we use the Washington Healthplanfinder to compare different plans and check for eligibility for subsidies or cost-sharing reductions based on your income level​ first. There are times that we go off-exchange for availability as we want our clients to have the ability to choose.

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Individual Health Insurance Is My Plan Going To Cost More Next Year?

Posted on by Matt McColm

Matt and Suzie have been helping people find health insurance that they can understand, use and afford. We are already seeing the challenges start to build with the changes to cost for next year.

The Washington Office of Insurance has released the proposed rate changes.

Yes, every year the rates are put out for public comment for the following year. They are not the final numbers. These remind me of the 2019 increases which means people will be shopping. Select your appointment now.

When to enroll in Health Insurance

Healthcare Open Enrollment starts October 1st runs to December 15th for plans starting January 1st.

If you have a major income adjustment then you want to select from December 1st through 15th.

If you select a healthcare plan from December 16 through January 15th then it will start February 1st.

Suzie appointment

Proposed Health Insurance rates for 2025:

I am putting in the links to make comments as it is important:

Asuris is off exchange increase 15.84% requested. Make comment Here

They made $789,164 and served 994 customers they also had 84.60% in claims.

Bridgespan Health Company increase 20.28% requested. Make comment here.

They lost $2,578,400 and served 544 customers they also had 86.24% in claims.

1st NCW Health Insurance Plan on Exchange

Community Health Plan of Washington (also known as Ambetter) increase 4.54% requested make comment here.

They lost $2,958,935 and served 23,598 customers they also had 85.19% in claims.

Suzie helping enroll health insurance or medicare

2nd NCW Health Insurance Plan on Exchange

Coordinated Care Corporation increase 12.15% requested. Make Comment here.

They lost $5,758,758 after risk adjustment and served 83,378 with 81.21% in claims

Suzie appointment

Kaiser Foundation Health Plan of Washington increase 6.4% requested. Make comment here

They lost $3,189,795 and served 7,232 in Clark and Cowlitz increase 6.4% with 86.48% in claims.

Kaiser Foundation Health Plan of Washington increase 7.88% requested. Make comment here.

They lost $15,507,921  and served 46,266 heavy risk adjustment payback with 86.73% in claims.

3rd NCW Health Insurance Plan on Exchange

Lifewise Health Plan of Washington increase of 8.03% requested. Make Comment here.

They made $3,570,521.20  and served 26,659 with 82.04% in claims.

Lifewise Health Plan of Washington increase of 6.9% requested. (Grandfathered Plans) Make Comment here.

They made $4,944,849  and served 2,224 with 81.91% in claims.

Molina Healthcare of Washington increase 7.55% requested. Make Comment here

They made $2,476.238  and served 41,454 with 82.02% in claims.

Premera Blue Cross increase of 14.87% requested. Make Comment here.

They made $10,754,109  and served 10,493 with 86.39% in claims.

Providence Health Plan increase 9.34% requested. Make comment here.

They lost $353,142  and served 246 with 82.95% in claims.

Regence Bluecross Blueshield of Oregon increase 16.8% requested. Make comment here.

They lost $2,655,266 after risk adjustment and served 8,397 with 85.44% in claims.

Regence Blueshield increase 23.81% requested. Make comment here.

They lost $6,585,594  and served 28,369 with 87.14% in claims.

United Healthcare of Oregon increase 23.56% requested. Make comment here.

They made $5,806.55 (thanks to risk adjustment)  and served 6,207 with 83.62% in claims.

Suzie appointment

Summary.

At Wenatchee Insurance, we enroll year round as people qualify for special enrollments. Plus we also take care of property insurance like cars, homes, and businesses alongside the Health, Medicare and Life Insurances.

Claims are driving up costs to insurance companies, who have to pass it on to consumers. Make your comments known. The more subsidy that you receive then the lower amount since the benchmark plan (second lowest cost silver plan available) will shift. There will be a lot of people shopping, select your appointment early as Suzie and Matt will run out of space available.

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Have you looked at Medicare C or Medicare Advantage?

Posted on by Matt McColm

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.

Suzie appointment

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!

Medicare Part C plans

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.

appointment with Suzie

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
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Is a PPO or a HDHP insurance plan better?

Posted on by Matt McColm
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.

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

Posted on by Matt McColm
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.

Check Family Glitch

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.

chat with Suzie

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.

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

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

Posted on by Matt McColm

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

chat with suzie

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

Annual SEPs:

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

child qualify Apple Health Coordinated Care

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

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

Short Special Enrollments:

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

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

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

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.

appointment with Suzie

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

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