Washington State and the new Prior Authorizations for Medicare

Posted on by Matt McColm
Prior authorizations in Washington state for original medicare

Beginning January 1st, 2026 some medical procedures under traditional Medicare will require Prior Authorization in six states before performing the service. Yes, Washington state has been selected. Arizona, New Jersey, Ohio, Oklahoma, and Texas.

This updates individuals with Medigap plans such as Plan G or Plan N, if they are using traditional Medicare coverages. While common in health plans and Medicare Advantage Plans these are new for original Medicare.

This change is part of a trial program called WISeR (Wasteful and Inappropriate Services Reduction). It is designed to curb medical overuse and detect potential fraud.

What Procedures will require a Prior Authorization?

There were 17 types of procedures that were flagged to now need approval. Here is what made the list.

  • Facet joint procedures for back pain
  • Nerve and muscle tests (electrodiagnostic testing)
  • TENS units and similar electrical stimulation devices
  • Hyperbaric oxygen therapy
  • Spinal cord stimulators
  • Deep brain stimulation (commonly for Parkinson’s)
  • Sacral neuromodulation (for urinary conditions)
  • Transcatheter aortic valve replacement (TAVR)
  • Arthroscopic knee cleaning or debridement
  • Vertebroplasty/kyphoplasty for spine fractures
  • Epidural steroid injections
  • Non-emergency ambulance transport
  • Botox injections for medical issues
  • Negative pressure wound therapy pumps
  • Hernia repairs
  • Lumbar spinal fusion
  • Skin graft substitutes for chronic wounds

Physicians will be required to submit documentation before the service is performed. If approval is not granted, coverage can be denied requiring the patient to pay out of pocket.

Who made this decision for Prior Authorization?

This was a rules change with the Centers for Medicare & Medicaid Services (CMS), Department of Health and Huma Services. Every administration picks there team to implement programs that they feel will have the biggest impact for consumers. They did a press release in June regarding this matter and it is estimating that they spent 25% of healthcare on services that had little to no clinical benefit. HHS Secretary Kennedy, CMS Administrator OZ pledge to fix Prior Authorization system.

At Wenatchee Insurance we do our best to lend a hand in understanding and enrolling in Medicare and insurance Programs. We are an independent insurance agency. If you are looking at supplemental policies then let us know and there are enrollment periods.

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How does TrumpRX work and can it save me money?

Posted on by Matt McColm
How does TrumpRX work

OK, Tariffs are playing an important role in what the administration is doing with drug pricing. TrumpRX appears to be using them to inflate the price on medication for companies that don’t participate with the administration. 

Trump is imposing a 100% Tariffs. Effective October 1st, 2025 if a company reaches an agreement with the Administration then they will be immune to them. There is the common consensus that everyone participating in this deal will have customers paying inflated costs due to the tariffs. 

Companies working with TrumpRX

  Pfizer is one of the first companies to reach an agreement. They are one of the largest drug companies and Eliquis, Ibrance and the Covid vaccine are among the drugs that they manufacture. Eliquis was one of the drugs with the Medicare Negotiated price for 2026.  Ibrance was selected for the Inflation Reduction Acts Medicare negotiated price for 2027. So thanks to the Inflation Reduction Act from the Biden administration, 

It also sounds like Novo Nordisk and Bristol Myers Squibb have also signaled participation. 

They will be doing a Direct to Consumer Model with a yet to be launched website. There is a marked page at TrumpRX.com but it is not functional as of publishing this blog. 

It could be very similar in the direct to consumer model of AmericasMedicines.com  from a Pharmaceutical trade group PhRMA where people can go directly to the manufacturers. 

It sounds like a stepped up version of Mark Cuban’s CostPlus. Where they have a few drugs that they ship directly to the consumer. 

Only time will tell if it has more savings than GoodRX. 

Health Insurance Dates

Important Dates for Medicare and Health

Medicare Advantage and Prescription plans can be enrolled or changed October 15 through December 7th. 

Healthcare Plans can be enrolled or changed November 1st through December 15th. 

For Washington State select an appointment at the Wenatchee Insurance Agency. 

Wenatchee Insurance Agency is an independent insurance agency. 

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Prepping Your Home for Storms: What to Do When a Flood is Likely

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Flood Insurance Washington

Floods can develop quickly and cause severe damage to your property. Taking proactive steps before and during a storm can help protect your home, belongings, and family. Here’s how to prepare when flooding is expected.

Safeguard Important Documents

Store essential items, such as insurance policies, IDs, medical records, and financial paperwork, in waterproof containers. Additionally, save digital copies on a secure cloud service to ensure you can access them even if the originals are damaged or lost.

Protect Your Property

Move furniture, electronics, and valuables to higher floors whenever possible. Elevate appliances and utilities such as HVAC systems, water heaters, and electrical panels to minimize the risk of costly flood damage. Use sandbags or flood barriers around doors and low entry points to help keep water out.

Prepare an Emergency Kit

Pack essentials such as bottled water, non-perishable food, medications, flashlights, batteries, and first-aid supplies. Having a kit ready ensures your family can stay safe and comfortable if you lose power or need to evacuate quickly.

Plan for Evacuation

Familiarize yourself with local evacuation routes and create a plan for pets, family members, and vehicles. Fill your car with gas ahead of time and keep emergency contact information easily accessible.

Review Your Insurance Coverage

Standard homeowners’ policies typically don’t cover flood damage. If you live in a flood-prone area, flood insurance is essential. Reviewing your policy before a storm strikes ensures you have the right protection in place when you need it most.

At Wenatchee Insurance Agency, We’re Proud to Serve Wenatchee, WA

Flood insurance can provide the security you need to feel confident that your home is protected. At Wenatchee Insurance Agency, we’re here to help you find the insurance products that make sense for your needs. Contact us today to learn more.

 

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Health Insurance and Your Privacy Rights

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Privacy is important to Matt and Suzie at Wenatchee Insurance

Maintaining your health can be a challenge, and paying for healthcare costs can make that challenge even harder. If you don’t get health insurance through your job, purchasing private health insurance can make a big difference to your budget. Privacy plays an important role. If you are in the Wenatchee, WA area, our team at Wenatchee Insurance Agency would like the opportunity to explain the benefits of health insurance.

Health Insurance and Your Privacy Rights

Today’s increases in technology use have brought many advantages, but they have also created opportunities for unauthorized access to personal information. Your health status and healthcare information are very personal. When you visit a healthcare provider, you don’t want to worry about whether your diagnosis, treatment, and medication information will be shared with anyone except the companies that need that information to work with you.

According to the Washington Office of the Insurance Commissioner, you have a right to privacy when it comes to your healthcare information. This means that your personal information can be shared only with sources that need to provide service to you. The same website assures you that you can have sole access to your healthcare information. Privacy is especially important for clients under the age of 18 who are legally entitled to consent to healthcare procedures, including procedures related to their reproductive rights.

Call Us for an Appointment Today

You never know when you’ll need an emergency medical procedure. Our team at Wenatchee Insurance Agency can help you find a policy that fits your needs and budget. Clients in the Wenatchee, WA area have discovered that our team is knowledgeable and provides consistently excellent customer service. Call us for an appointment today, and let’s work together to find the right insurance policy for you.

 

 

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Please note during the Fall Enrollment Periods.

Medicare Annual Enrollment Period is October 15 through December 7.

Healthcare Open Enrollment Period is November 1 through December 15 (for plans starting January 1).

There are only so many hours in the day. Please select an appointment as early as possible or give us a call.

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How Term Life Insurance Works

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term life insurance is important

Term life insurance is one of the most popular types of life insurance. It works very differently from another type called whole life insurance and comes with its own advantages and disadvantages. Many people choose this type of insurance to protect their loved ones after they pass away. However, term life may not be right for everyone interested in life insurance. Some people prefer the benefits of whole life policies, while others find that term life better suits their needs. To learn more about term life insurance, contact Wenatchee Insurance Agency in Wenatchee, WA.

A Set Period

Term life insurance gets its name from the set term of time during which the policy remains active. These policies have a specific expiration date, which can range from 10 to 25 years, among other options. Once that term has passed and the policyholder is still alive, the policy expires. At that point, the policyholder would need to purchase a new policy to maintain coverage. The trade-off is that term life policies are highly budget-friendly and more affordable for many people who may not be able to afford a whole life policy.

The Death Benefit

Term life insurance functions similarly to other types of life insurance, as it pays a death benefit to beneficiaries upon the policyholder’s passing. This is the primary purpose of life insurance, as it provides financial support for loved ones left behind. The amount of the death benefit is determined at the time the policy is written. Generally, higher coverage amounts are accompanied by higher premiums.

Get Life Insurance in Wenatchee

If you don’t have life insurance, now is the time to get a policy to protect your loved ones. To get started with a policy of your own, contact Wenatchee Insurance Agency in Wenatchee, WA today.

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Where can I find fresh fruit stand in Central Washington?

Posted on by Matt McColm

Since Wenatchee Insurance is located in the Apple Capital of the World, we do our best to meet the Orchards and small businesses in our area. One of the ways that we are able to is by visiting their fruit stand during harvest. We do our best to carry cash to lower transaction fees. If you want fresh fruits & vegetables while putting money directly into farmers hands then this is one of the best ways to do it.

While there are some very large tourist driven stands, we have been doing our best to visit the smaller operations. Some of these we have been visiting 20 plus years while others it has been our first stop. We are doing farm house rules by purchasing something fresh and something preserved.

Here is the map:

Fruit stands in Central Washington visited by Wenatchee Insurance
2025 Fruit stand visit map

visiting a fruit stand

Eagle Rock Fruit Stand in Cashmere
Great for apricots and cherries in Cashmere

Eagle Rock Fruit Stand: address 4911 Selfs Motel Rd, Cashmere, WA 98815 : Phone: (509) 470-6292 Facebook Page; Just did their 20th Anniversary. One of the most affordable that we found for cherries.

Peachman

The Peachman (formerly Tonz Ochards): address is 4820 Cascade Ln, East Wenatchee, WA 98802: Phone (509) 630-4674 Facebook Page One of the few places where we were able to find Pie Cherries. They had a great selection of pickled goods. We pulled a bottle of Peach syrup out of here.

located at the base of Blewett Pass, Miller Orchards has some high quality fruit.

Miller Orchards: address is 7306 US-97, Peshastin, WA 98847 : phone (509) 669-3784 Facebook Page Yes, this is where Matt can find his Santini Cherries. They have very high quality produce and we were able to get some amazing blueberries from here as well.

Lake Entiat Fruit stand: address 14360 US-97 ALT, Entiat, WA 98822 ; phone number (509) 393-0539 website Facebook We had some amazing strawberries out of here. Seriously, our car smelled delightful from the ride home. Matt also picked up marinated mushrooms which is hard to find.

Homestead Fruit Stand Entiat

Homestead Fruit Stand: address 7920 State Highway 97A, Wenatchee, WA 98801; phone number (509) 665-8243. They had some great produce and we were able to pull some ripe tomatoes. This is the first stand into Entiat from Wenatchee. They had a good selection of Lavender.

DeLap Fruit Stand in Malott can sometimes be found at the Okanogan Farmers Market

DeLap Fruit Stand: address milepost 275 Hwy 97 Malott, WA, United States, Washington 98829; phone number (509) 422-3145; Facebook page; They have some fruit that you may not have had before. You can find Apruims and Pluots. They have one of the dancing guys and are an easy stop off Hwy 97.

Estes Fruit stand with Suzie great stop for apple, cherries and pickled goods!

Estes Fruit Stand and Flowers: address 13656 US-2, East Wenatchee, WA 98802; phone (509)884-2034; Facebook page ; This was one of my mother’s favorites. They have this amazing flower selection and this was the earliest that that I spotted this year’s apples as they had some early varieties.

E & E Fruit Shack East Wenatchee

E & E Fruit Shack; address 4th St SE, East Wenatchee, 98802. There is no website or Facebook page. It is however right next to the family’s orchard. We were able to pick up some great plums, they also had peaches, and a bunch of zucchini. If you want to put money directly into a farmer’s hands then this is where you want to pick up fruit here at least once during the season.

Feil Pioneer Fruit Stand in East Wenatchee with Suzie from Wenatchee Insurance

Feil Pioneer Fruit Stand: 13083 US-2; East Wenatchee, WA 98802. Phone number 509-669-1754. This is right on the highway next to the round about. Great selection of fresh fruit. The earliest spot that we found Pears and Apples. They even had a great selection of tomatoes.

Preys Fruit barn outside of Leavenworth with Suzie

Prey’s Fruit Barn: 110007 Hwy 2, Leavenworth. Phone number 509-548-5771. Facebook page webpage This is right outside of Leavenworth with the large American Flag. They had a good assortment of fruit and are open year round. Very tourist friendly and we were able to pick up unusual sodas.

Bonus: The Local Granola: address 1408 Main Street Oroville, WA, United States, Washington 98844; phone number (509) 476-7037; webpage Facebook They offer a small natural foods selection. The Granola is worth the stop. We also got beard supplies.

Rules for fruit stand visits.

  1. Bring cash. The smaller operations will appreciate you as they don’t have to make transaction fees.
  2. Don’t be afraid to call ahead or ask if you don’t see something. It’s literally how I got Pie Cherries.
  3. When you find one that is awesome then take a picture and share them on Facebook. Bonus points if you tag them so that more people can find them.
  4. If we missed a favorite one then let us know in the comments.
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Insurance Questions for Crop Insurance in Washington

Posted on by Matt McColm

At Wenatchee Insurance, we lend a hand to farms and orchards with a wide background. Insuring your family business can be tricky and adding crop insurance requires some skills. Some folks are looking for a Multi- Peril Crop Insurance where others are needing Whole Farm Revenue Protection. Living in the Apple Capital of the World, we have have run between the trees more than once.

We will ask questions so that we can get a better picture about your orchard or farm to make sure that you are not creating a coverage gap. For us, we believe that insurance should be:

  1. Affordable. If you can not pay for it then it doesn’t make sense.
  2. Understandable. This creates big problems if someone has something that they don’t know how it works.
  3. Useable. If an emergency arises then we want you to be able to use it.
crop insurance is important at Wenatchee Insurance

Crop insurance questions

  1. What is the address of your orchard or farm?
  2. What is the name of the orchard or farm?
  3. Who has an interest in the orchard beyond yourself?
  4. What is your and any other people with interest’s SSN?
  5. What is the business’ EIN (If individual SSN or RAN is fine)
  6. Are you leasing the orchard?
    • If so what is the % agreement?
  7. What fruit or crop are you growing?
  8. How many acres do you have of which crop?
  9. What are the last 5 years of production? We will need it by block if possible
    • If new farmer can you procure the previous farmer’s records?
  10. Are you tearing out any part of your orchard for next year? Or is there any new tree you think will produce this year?
  11. Anything you think I should know?

What’s next to insure your crops?

After collecting the information, we go looking for coverage that covers your needs. What works for Farmer Fred’s potatoes in Quincy may completely miss Oliver Pear Orchard in Cashmere. Not everyone needs or can get crop insurance. We do our best to be responsive whether it is you talking or if you are sending your spouse.

When you are ready let’s talk. We have found that a conversation is a great way to begin.

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Insurance Questions for Retail business insurance in Washington

Posted on by Matt McColm
we support small business and equity

At Wenatchee Insurance, we lend a hand to business owners with a wide background. Business insurance can be tricky. Some are just starting their journey where some have been running their family business for five generations. We even got involved with lending a hand with assisting Enterprise For Equity to help people better insure their business.

We will ask questions so that we can get a better picture about your business to make sure that you are not creating a coverage gap. For us, we believe that insurance should be:

  1. Affordable. If you can not pay for it then it doesn’t make sense.
  2. Understandable. This creates big problems if someone has something that they don’t know how it works.
  3. Useable. If an emergency arises then we want you to be able to use it.
commercial auto wenatchee insurance or business insurance

Retail business insurance questions

1) What is the official name of your business?

2) What is the address where you operate? Is it online only home based?

3) Do you have a different mailing address? If so What?

4) What is a your business phone #?

5) How much do you think you’re going to be making this year?

6) Does anyone else own a stake in the business?

7) Do you use your car to make deliveries?

8) What is the product/s you sell?

9) How many employees will you have?

10) Are there any additional insureds? (Landlords/owners)

11) Anything you think I should know?

What’s next to insure your business?

After collecting the information, we go looking for a good insurance company that fits your business. Some insurance companies may charge more or even not cover something that you need. What works for Farmer Fred in Quincy may completely miss Oliver Orchard in Cashmere. Not everyone needs crop insurance. The old company that your grandfather used may not cover the drones that you are using today.

When you are ready let’s talk. We have found that a conversation is a great way to begin.

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Apple Health Dental changes can be scary if you don’t know.

Posted on by Matt McColm
Apple Health or medicaid is free health insurance

Yes there has been a big change to Apple Health in regards to Dental Care. Yes, we write a lot of dental Insurance at Wenatchee Insurance. As part of the budget the Adult and children’s Apple Health (Medicaid) dental rates are being reduced effective July 1st, 2025.

In our area we have a select few dentists and orthodontists that accept Apple Health. When our son needed braces, every six weeks we would make the drive from Wenatchee to Ellensburg so that he would have his teeth worked on. It took a lot of coordination between his pediatric dentist and the orthodontist to get the approval.

Where to find Apple Health Dental care?

OK, have you been to the Dentist Link Set up by the Healthcare Authority? It provides an excellent search tool to find a dentist accepting Apple Health Dental in your area. You can also call or test a referral specialist 844-888-5465 from 8 am to 4:30 pm on weekdays.

Adult Apple Health covers a lot of different things.

What does Apple Health Dental cover for adults?

If you have Apple Health as an adult it covers more than people think. Yes, it really does take care of fillings, front teeth root canals and dentures. There are some things that it doesn’t cover by it’s self like Dental Implants and Adult Orthodontics.

How do I enroll?

Suzie and Matt have been assisting people enroll for over a decade into Apple Health plans. We have never charged a fee and do not get paid for enrolling people in these plans. We do it because people in our community use healthcare and it is expensive to go without. There are no enrollment periods with Apple Health and it is based on our income level.

Children have expanded access to Apple Health using the Children’s Health Insurance Program (CHIP). Some will be zero cost or there will be a $20 or $30 monthly charge per child fee. We have a lot of families where the parents are on a paid health plan and the kids are on Apple Health. The important thing is that the family is being covered.

What happens if I am no longer eligible for Apple Health Dental

We have the conversation. We have access to several dental plans that a person can enroll year round. Some with waiting periods and some without. We even have plan that can assist adults with getting braces after a waiting period at Wenatchee Insurance. We make it as easy as possible to review your options.

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Enrollment Periods

There are times when it get’s incredibly busy for healthcare so you may have to wait a little bit longer in the Fall.

For Medicare the Annual Enrollment Period for Medicare Drug Plans and Medicare Advantage plans is October 15th through December 7th.

For Medicare’s Initial Enrollment it is three months before you turn 65, the month of your birthday and three months after.

For Healthcare the Open Enrollment Period is November 1st through December 15th. (some states may have an extension so do not hesitate to ask).

Yes, people set appointments early in the year for fall appointments to insure that they are able to have a conversation about the changes to their health plan.

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What Does No-fault or PIP Mean in Insurance Terms?

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local car insurance wenatchee PIP No-fault

The term “no-fault” in auto insurance can be confusing, especially if you’ve never had to file a claim. While it might sound like it removes responsibility, that’s not entirely accurate. Instead, no-fault insurance refers to how claims are handled after an accident, specifically, how medical bills and related expenses are paid, regardless of who caused the crash. Here’s an explanation from your insurance representative at Wenatchee Insurance Agency, serving Wenatchee, WA.

How No-Fault Insurance Works

In states that follow a no-fault system, each driver’s insurance policy covers their own policyholder’s medical expenses after an accident, up to a certain limit. This happens regardless of who was at fault. The primary goal of no-fault insurance is to reduce lawsuits related to minor accidents and ensure injured drivers receive treatment quickly.

Washington is not a traditional no-fault state, but drivers here have the option to add Personal Injury Protection (PIP) coverage to their policies. PIP functions similarly to no-fault insurance, covering medical expenses, lost wages, and essential services without waiting for a liability determination.

What No-Fault Insurance Does Not Cover

No-fault insurance does not cover damage to your vehicle or someone else’s property. These types of claims still require determining fault, with the at-fault driver’s liability coverage typically paying for repairs. Additionally, in serious accidents involving significant injuries, lawsuits may still be permitted—even in no-fault states—if damages exceed policy thresholds.

Know Your Options in Washington

Since no-fault insurance is optional in Washington, it’s important to review your policy and understand the level of protection you have. Adding PIP coverage can provide an extra layer of financial support if you’re injured, even if the other driver is uninsured. Your experienced local agent at Wenatchee Insurance Agency, serving Wenatchee, WA, can help you determine if this coverage is right for you. Contact us today to learn more.

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