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Wenatchee, WA 98801

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What Are the Differences Between Medicare and Medicaid?

Medicare or Medicaid a conversation about the differences

Hey, it’s Wenatchee Insurance! We are answering a classic question today, what are the differences between Medicare and Medicaid. We are going to use a Golden example:

It’s 2024, you’re sitting with Blanche, Dorothy, Rose, and Sophia in Miami, and you’re scratching your head over the differences between Medicare and Medicaid. Sit tight and grab a cheesecake because we’re about to unravel this mystery Golden Girls style!

Medicare: The Senior Superstar

Dorothy: “Alright, let’s start with Medicare. It’s like Stan – it’s been around forever. Medicare is a federal program mainly for folks aged 65 and older. It also covers younger individuals with certain disabilities and those with End-Stage Renal Disease (ESRD). Think of Medicare as the golden ticket for our seasoned citizens.”

Medicaid: The Need-Based Nurturer

Blanche: “Oh honey, Medicaid is a whole different ball game. It’s a joint federal and state program that helps people with limited income and resources. It’s like that nice gentleman who insists on paying for your drinks at the Rusty Anchor – it’s there to lend a hand when you need it most.”

Who Qualifies?

Medicare:

Rose: “If you’re 65 or older and worked your credits, congratulations, you qualify! But even if you’re younger and have disabilities or ESRD, you’re still in the club.”

Medicaid:

Sophia: “Eligibility for Medicaid is trickier than finding a good cannoli in Miami. It depends on your income, family size, and sometimes disability or other factors. Each state has its own rules – it’s like trying to follow Rose’s stories about St. Olaf.”

Example Time!

Dorothy: “Meet George, a 68-year-old retiree. He’s eligible for Medicare because he’s over 65. Now, consider Anna, a single mother with a low income. She qualifies for Medicaid to help cover her children’s medical expenses. Simple as pie, right?”

health or medicare enrollment suzie makes it easier

What Do They Cover?

Medicare:

Blanche: “Medicare’s got you covered for hospital stays (Part A), doctor visits and outpatient care (Part B), Medicare Advantage (Part C), and prescription drugs (Part D). It’s like having a fabulous wardrobe – everything you need, you just have to mix and match beforehand .”

Medicaid:

Rose: “Medicaid covers a broader range of services, including hospital and doctor visits, long-term care, and sometimes even dental and vision care. It’s like the St. Olaf Cheese Festival – there’s something for everyone!”

Example Time!

Sophia: “Imagine Sue, who has both Medicare and Medicaid (dual eligibility). Medicare covers her hospital and medical expenses, while Medicaid helps with additional costs like long-term care and some out-of-pocket expenses. Sue’s got the best of both worlds – like having cheesecake for dinner and dessert!”

How Are They Funded?

Medicare:

Dorothy: “Medicare is funded by payroll taxes, premiums, and general revenue. It’s as straightforward as Blanche’s love life – always funded by someone.”

Medicaid:

Sophia: “Medicaid, on the other hand, is jointly funded by the federal government and the states. The feds match state spending, with the match rate varying by state. It’s like a family potluck – everyone brings something to the table.”

Example Time!

Rose: “Think of Medicare as a national program with uniform rules. Medicaid is more like St. Olaf’s festivals – each state adds its own unique twist to the overall picture.”

Wenatchee Insurance: Your Dual Eligibility Expert

Blanche: “Navigating the differences between Medicare and Medicaid can feel like one of Rose’s long stories. But don’t worry, darling, Suzie at Wenatchee Insurance is here to guide you through every twist and turn.”

Dorothy: “Our knowledgeable agents can help you understand which program you qualify for and how to make the most of your benefits. Remember, understanding Medicare and Medicaid doesn’t have to be a puzzle.”

Sophia: “With Wenatchee Insurance by your side, you’ll find your way in no time. So stay tuned for more insights, tips, and helpful advice. And always remember – thank you for being a friend!”

calling suzie for medicare or health insurance help

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

Are There Any Exclusions or Limitations in My Policy That I Should Be Aware Of?

We like to review policies with our clients at Wenatchee Insurance to look for exclusions or limitations.

exclusions can limit your insurance your policy

Exclusions and Limitations basics:

The Fine Print Follies

Reading the fine print of your home insurance policy can feel like deciphering an ancient scroll. But fear not! Wenatchee Insurance is here to help you uncover any exclusions or limitations, with a touch of humor to keep you entertained.

The Mystery of the Mold Exclusion You might think mold is just a minor inconvenience, but in the insurance world, it’s often excluded. It’s like finding out King Pizza doesn’t deliver to your side of the Columbia River – a disappointing surprise!

The Infamous Flood Exclusion Floods are the party crashers of natural disasters, not covered by standard homeowners’ policies. Make sure you have separate flood insurance, or you’ll be left high and dry – or rather, wet and uninsured.

Lenders will require flood insurance when you move to certain FEMA-designated flood zones so be prepared for this added cost when buying a new home.

The Earthquake Enigma Earthquakes aren’t always part of the standard package. It’s like ordering a burger and realizing fries are extra. We do get tremors in Washington state, so consider adding earthquake coverage to avoid a costly shake-up.

The Termite Terror Termites might be small, but they can cause big damage. Unfortunately, most policies exclude insect damage. It’s like finding out your least favorite insect is planning a surprise visit. Regular inspections and pest control can help keep them at bay.

exclusions and limitations can rope off your insurance policy from use

The Mysterious Maintenance Issues Routine maintenance issues like plumbing leaks or roof repairs are generally your responsibility. It’s like realizing you have to do your own laundry – a necessary chore that insurance won’t cover.

The Pet Problem Got a furry friend with a penchant for destruction? Most policies don’t cover pet-related damage. It’s like discovering your adorable puppy has a dark side. Keep Fido out of trouble to avoid any unpleasant surprises.

Summary

Wenatchee Insurance helps you navigate the fine print so you’re never caught off guard by exclusions or limitations. Stay informed and stay protected!

Topics: Wenatchee Insurance, Deductible, Home Insurance, Bundle, Chelan, Fire, Okanogan, Grant, Medicare, health, Wind, Liability, flood, Cheap Insurance, Exclusions

Insurance Bundle

What does Medicare Cost?

medicare does cost even medicare advantage

Hey North Central Washington, from Wenatchee Insurance on Mission street! Today, we’re diving into the nuts and bolts of Medicare cost. Understanding these costs will help you make the best decisions for your bank account and health.

Breaking Down the Medicare Costs

Medicare isn’t free, but understanding its costs is as easy as pie (or at least as easy as a slice). (When Medicare first came out in 1966, the annual deductible for Part A was $40, and the monthly premium for Part B was $3.) There are programs for low income however that is another post. Here’s the breakdown:

Medicare Part A: Hospital Insurance

  • Premium: Most people don’t pay a premium for Part A if they’ve worked and paid Medicare taxes for at least 10 years (40 quarters). If you haven’t, you might pay up to $506 per month.
  • Deductible: In 2024, the deductible for each benefit period is $1,600.
  • Coinsurance: After the deductible, you pay coinsurance for hospital stays:
    • Days 1-60: $0 per day
    • Days 61-90: $400 per day
    • Days 91 and beyond: $800 per “lifetime reserve day” (up to 60 days over your lifetime)

Medicare cost example!

Meet Sam, who’s 65 and newly retired. Since he worked for over 30 years, he doesn’t pay a Part A premium. After a brief hospital stay, he’s grateful his deductible and coinsurance costs are manageable.

Medicare Part B: Medical Insurance

  • Premium: The standard premium for Part B in 2024 is $164.90 per month, but it can be higher based on your income (IRMAA).
  • Deductible: The annual deductible is $233.
  • Coinsurance: After meeting the deductible, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment.

Note: The Income-Related Monthly Adjustment Amount (IRMAA) is based on the tax return of the previous two years.

Medicare cost example!

Consider Lucy, who loves her yearly wellness visits. She pays her monthly Part B premium and a small deductible, but thanks to Medicare, her out-of-pocket costs for doctor visits and preventive care are minimal.

Part C: Medicare Advantage

Medicare Advantage Plans vary in cost, depending on the plan and provider. Some plans have low or even $0 premiums but may have different deductibles, copayments, and out-of-pocket maximums. These plans vary from company to company and can even be different by zip codes in the same state. We recommend having a trained person walk you through these plans.

Medicare cost example!

Picture John, who chooses a Medicare Advantage Plan with a $50 monthly premium but no additional deductible. His plan includes vision and dental coverage, making it a sweet deal for his needs.

Part D: Prescription Drug Coverage

  • Premium: Varies by plan, with an average of around $33 per month.
  • Deductible: Some plans have a deductible, which can be up to $480.
  • Copayments/Coinsurance: Costs vary based on the medication tier and whether you use a preferred pharmacy.

Note if you do not sign up for Part D or have credibly prescription coverage then you can have a penalty from Medicare.

Wenatchee Insurance: Your Budget Buddy

At Wenatchee Insurance, we understand that navigating Medicare costs can feel like assembling a financial jigsaw puzzle. But don’t worry – we’re here to help you piece it all together. Suzie at Wenatchee Insurance can provide personalized guidance and ensure you understand all the costs involved.

Remember, folks, planning for Medicare doesn’t have to be a budget-busting headache.

Are Secret Discounts Available for Home or Bundling Policies?

Unlocking the Secret Discounts

Wenatchee insurance bundling Health insurance, Medicare, Life, Car, Home in for secret discounts

Shh… Can you keep a secret? Wenatchee Insurance has secret discounts that can save you big bucks on your home insurance. It doesn’t always have to be with the same company or type of insurance! Let’s embark on a treasure hunt to uncover these elusive savings.

The Safe Home Bonus Installing safety features in your home is like finding a hidden stash of gold coins. Smoke detectors, alarm systems, and deadbolt locks can earn you discounts. Your home becomes a fortress, and you fend off the inflation bandits for the year.

The Golden Parachute of Savings. Keep your receipts, if you have a roof that is less than ten years old then you could be entitled to some savings. Age plays a tremendous role for underwriters being able to cover your home.

The Bundling Bonanza Why stop at home insurance when you can bundle with auto insurance and save even more? It’s like finding a two-for-one deal at your favorite store. Bundle your policies with Wenatchee Insurance. Some companies allow us a discount if you have a Health or Medicare policy with us.

The Claim-Free Treasure Been a good sailor with no claims? Wenatchee Insurance rewards you for smooth sailing. The longer you go without filing a claim, the more you save. Boring is better when it comes to pleasing the underwriters.

The Loyalty Loot Sticking with Wenatchee Insurance pays off. Loyal customers often receive discounts just for being awesome and staying with the same insurer. It’s like getting a thank-you gift for being part of the family.

So, grab your treasure map and start hunting for those hidden discounts with Wenatchee Insurance. Your savings adventure awaits!

Topics: Wenatchee Insurance, Deductible, Home Insurance, Bundle, Chelan, Fire, Okanogan, Grant, Medicare, health, Wind, Liability, Cheap Insurance, independent insurance broker,

What Are Medicare Advantage Plans?

medicare advantage mutlitool of health

Greetings, Wenatchee Insurance aficionados from Mission Street! Today, Suzie is shining a light on the mystery of Medicare Advantage Plans, also known as Part C. Think of these plans as the Renaissance Man of the Medicare world, combining various benefits into one convenient bundle.

Medicare Advantage: The Healthcare Multi-tool

Medicare Advantage Plans are offered by private insurance companies approved by Medicare. These plans include all the benefits of Part A (Hospital Insurance) and Part B (Medical Insurance), and may also include Part D (Prescription Drug Coverage). A Medicare Advantage plan is like a subcontractor. They come in and replace your Part A & B coverages and add different benefits.

While they have undergone changes through the years, Private plans have been around since the beginning of Medicare in 1966. Medicare Advantage plans must cover all medically necessary services that Original Medicare Covers.

Example Time!

Imagine Mary Jo retires and wants to simplify. Instead of juggling separate plans, she opts for a Medicare Advantage Plan that places everything in a convenient package. Mary Jo now has more time to enjoy gardening and less time digging through the different health insurance options.

Medicare Advantage senior in the flowers

Extra Perks: More Than Just Basics

Medicare Advantage Plans often offer additional benefits that Original Medicare doesn’t cover, such as:

  • Vision care: Routine eye exams and glasses
  • Dental care: Cleanings, x-rays, and dentures
  • Hearing care: Hearing exams and hearing aids
  • Wellness programs: Gym memberships, fitness classes, and more

Medicare Advantage plans vary by company and some cases by zip code so it is important to review the benefits based on your address.

Example Time!

Meet Jimmy, an avid cyclist and fitness enthusiast. His Medicare Advantage Plan includes a fitness program, giving him access to numerous gyms and fitness classes at no extra cost. Jimmy’s cycling buddy Fred in a neighboring state has the same company but his plan does not include the fitness program. Jimmy learned about the fitness plan benefits by carefully reviewing the Medicare Advantage plan materials.

Medicare Advantage Senior using benifits

Choosing the Right Plan

Selecting the perfect Medicare Advantage Plan can feel like choosing the right flowers for your garden– so many options! Here are some factors to consider:

  • Network: Check if your preferred doctors and hospitals are in-network.
  • Costs: Compare premiums, deductibles, copayments, and out-of-pocket maximums.
  • Coverage: Ensure the plan covers your medications and any extra benefits you need.
  • Ratings: Look at the plan’s star ratings to gauge its quality and performance.

Example Time!

Consider Jane, who needs regular medication for a chronic condition. She carefully reviews different Medicare Advantage Plans to find one that covers her prescriptions and includes her trusted healthcare providers. With Suzie @ Wenatchee Insurance’s help, Jane selects a plan that fits her needs.

Suzie @ Wenatchee Insurance has been assisting people with Medicare for over ten years.

Navigating the variety of Medicare Advantage Plans can be tricky, but that’s where Wenatchee Insurance can lend a hand. Our trained agents are here to guide you through the options, explain the benefits, and assist you in making an educated decision on which plan is right for you.

Remember, folks, understanding Medicare Advantage doesn’t have to be underwater basket weaving. You’ll find a great plan in no time with Wenatchee Insurance by your side. Stay tuned for more insights and tips!

Insurance Bundle

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

How Is the Value of My Home and Personal Property Determined?

Family home insurance washington state

The Home Insurance Price Is Right!

Welcome to “The Home Insurance Price Is Right!” where you don’t have to guess the price, but you do need to understand how it’s determined. Let’s dive into the thrilling world of replacement costs and actual cash value with Wenatchee Insurance.

They don’t teach us the difference between Replacement Cost and Actual Cash value in High School nor when you were home eating crackers and sipping tea. We like to go over it because we don’t like surprised clients.

Replacement Cost: The High Roller’s Choice Imagine winning a fabulous new dining room set on our show. Replacement cost coverage means you get a brand-new version of your old stuff. No depreciation here, folks! It’s all shiny and new, just like the day you bought it.

Actual Cash Value: The Bargain Hunter’s Delight For those who love a good deal, actual cash value coverage considers depreciation. It’s like buying a gently used couch from a thrift store – still great, but not quite brand new. Your payout reflects the current market value of your items.

Sometimes Actual Cash Value is the only option available. It is worth the conversation if you see this valuation on your home owner’s policy.

Spin the Wheel of Claims! When it’s time to file a claim, Wenatchee Insurance uses their magical wheel (or more likely, some sophisticated calculations) to determine the value of your home and belongings. Don’t worry, they’re experts at making sure you get the right amount.

So, come on down to Wenatchee Insurance and find out how much your home and personal property are worth. It’s always a win when you’re properly covered!

Finding Medicare Advantage Plans with Suzie at Wenatchee Insurance

assistance in understanding and enrolling with Medicare with Suzie

Mary, a resident of North Central Washington, was approaching her 65th birthday and wanted to select a Medicare Advantage plan. She was overwhelmed by the numerous options and unsure how to compare them. She decided to contact Suzie at Wenatchee Insurance for guidance.

Understanding Medicare Advantage Plans

Medicare Advantage plans, also known as Part C, offer an alternative to Original Medicare. These plans are provided by private insurance companies and often include additional benefits like vision, dental, and prescription drug coverage. Each plan is rated based on preventive care, management of chronic conditions, member experiences, and customer service.

Mary’s Experience

When Mary contacted Wenatchee Insurance, an Suzie helped her understand the different plans available in her area. They discussed the star ratings of various plans and compared their benefits. Mary learned about the top-rated plans and how they cater to specific healthcare needs.

Choosing the Right Plan

With the Suzie’s help, Mary selected a Medicare Advantage plan that was highly rated and included comprehensive benefits suited to her health requirements. Wenatchee Insurance made the process straightforward by providing clear comparisons and expert advice.

Mary was relieved to have found a plan that offered excellent coverage and fit her budget, thanks to the assistance from Wenatchee Insurance.

Insurance Bundle

Managing Medicare Supplement Costs with Suzie and Wenatchee Insurance

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.

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).

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

Toothaches are no joke, let’s find good dental insurance

Wenatchee Insurance, we work with a variety of companies to find which plan works best for the client. Some have waiting periods which is why we like to review plans with clients before they buy them.

Dental insurance works kind of like having a quirky best friend who sometimes covers your tab and other times makes you pay your own way. Let’s break it down:

Types of Dental Insurance Plans

  1. Preferred Provider Organization (PPO)
    • Description: Imagine you have a favorite pizza place, but you sometimes cheat with other pizzerias. PPOs let you see any dentist, but you save more if you stick with the plan’s favorite pizza… er, dentist.
    • Pros: More freedom to cheat on your dentist.
    • Cons: Your wallet might feel the betrayal if you go out-of-network.
  2. Health Maintenance Organization (HMO)
    • Description: This is like having a strict diet plan where you can only eat at certain places. HMOs make you stay within the network, or else!
    • Pros: Your wallet stays on a strict diet.
    • Cons: Less freedom to indulge in dental decadence.

Coverage Categories

Dental insurance likes to categorize things because, apparently, it’s very organized. Here’s the scoop:

  1. Preventive Care
    • Examples: Routine exams, cleanings, X-rays.
    • Coverage: 100% covered because who doesn’t like free stuff?
  2. Basic Procedures
    • Examples: Fillings, extractions, periodontal treatment.
    • Coverage: They’ll cover 70-80%, which means you’re still paying a bit, but hey, it’s better than footing the whole bill.
  3. Major Procedures
    • Examples: Crowns, bridges, dentures.
    • Coverage: Only 50%, because apparently major procedures are the fancy, designer shoes of the dental world.

Key Features

  1. Premiums
    • Description: The monthly or annual fee you pay just to be part of this exclusive dental club. Think of it as your ticket to the show.
  2. Deductibles
    • Description: The amount you pay out-of-pocket before your insurance says, “Okay, now I’ll help.” It’s like having to eat your veggies before getting dessert.
  3. Copayments and Coinsurance
    • Description: Your share of the costs for covered services. It’s like going Dutch on a date – you both chip in.
  4. Annual Maximum
    • Description: The max amount the insurance will pay in a year. Once you hit that, it’s like the insurance saying, “I’m tapped out, buddy. You’re on your own.”
  5. Waiting Periods
    • Description: The time you have to wait before certain procedures are covered. It’s like a countdown to Christmas, but less exciting.
  6. Network Restrictions
    • Description: Some plans require you to use specific dentists. It’s like only being allowed to shop at one store for all your dental goodies.

Example Dental Insurance Scenario

Let’s say you have a PPO plan with:

  • A $50 deductible (the price of admission).
  • 100/80/50 coverage (the friend who’s sometimes generous).
  • And a $1,500 annual maximum (the friend who’s great until they run out of cash).

For a routine cleaning:

  • Cost: $100
  • You pay: $0 (because preventive care is like the free bread at a restaurant).

For a filling:

  • Cost: $200
  • You pay: $40 (20% coinsurance after the deductible, like tipping the waiter).

For a crown:

  • Cost: $1,000
  • You pay: $500 (50% coinsurance, because crowns are fancy).

So, there you have it. Dental insurance is like having a sometimes generous, sometimes stingy friend who helps you out with dental bills but also makes you chip in and follow some quirky rules. Enjoy the ride, and may your teeth be ever shiny!

We can add dental insurance year round at Wenatchee Insurance.

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What in the heck is Full Coverage Car Insurance?

Wenatchee Insurance Car Full Coverage

When we talk about “full coverage” car insurance at Wenatchee Insurance, we mean a bundle of insurance types that provides greater protection for your car.

Here’s what full coverages usually includes:

Liability Insurance: This is a must-have. It pays for any damage or injuries you cause to others if you’re responsible for an accident. Washington State requires a minimal amount so you may want more to be safe.  

Collision Insurance: This part covers damage to your car if you get into an accident, no matter who caused it. It’s usually required by the bank if you still owe money on your car because it helps fix or replace it. Pay attention to any deductible.

Comprehensive Insurance: This covers other types of damage to your car not caused by an accident. Mean people, dumb animals and acts God. For example: If your neighbors’ pitbull chews off your tire then you have coverage. Pay attention to any deductible.

SUV full coverage car not bullet proof

Uninsured/Underinsured Motorist Protection: This helps cover costs if another driver causes an accident and doesn’t have enough insurance (or any at all) to pay for the damage to you or your car. With 1 in 5 drivers in Washington state not having insurance, this can be incredibly handy.

Additional full coverage information:

Banks and other places that lend money for cars often require you to have all these types of insurance. They do this to protect their investment in your car while you’re still paying it off. It makes sure your car stays in good shape and keeps its value as long as you owe money on it. This setup keeps both you and the lender secure until you finish paying for your car.

If you are expecting your transmission to be repaired when breaks down, your laptop replaced after being stolen from your trunk, or your after-market parts replaced when not listed on your policy then you are going to be upset because those require other than full coverage. Let’s talk.

auto insurance couple luxury car

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Suzie Health Solutions

Health & Medicare

For nearly a decade we have assisted with Health & Medicare Solutions. We are proud to be selected by the Washington Healthplanfinder to be one of ten Enrollment Centers located in Washington State.

We work with all ages and charge no fees.

Health & Medicare

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