The Office of the Insurance Commissioner has approved rates for 2025. Washington state is looking at an average of 10.7% rate increase for 2025 for individual health insurance. For many people this will be a first look at what to expect before the Open Enrollment.
November 1 – December 15 for Health Insurance 2025 plans.
Why is this occurring?
The cost of care is a big factor in driving the costs. All the plans spent more than 80% of premiums on claims. The Affordable Care Act requires the insurance companies to either spend at least 80% on claims or else they have to issue rebate checks to the policy owners. A couple of the companies had significant risk adjustment payments that drove down their profitability as well. The Office of Insurance has made a five suggestions on how to lower the rates and we will see if the state legislatures respond.
How does it impact me?
It is important to shop your health insurance plans. Since you had a birthday then you know that the price went up. Also since we are dealing with an average, some plans may increase while others decrease to arrive at that average. If your tax subsidy is small then you will notice the increase more. If you qualified for a plan regardless of immigration status then you will notice the increase more because you don’t receive the federal subsidies.
Why setting an appointment early is important?
Suzie and Matt are seeing big changes for 2025 when it comes to Insurance.
Dreamers have a Special Enrollment starting November 1st
Average increase of over 10% for individual health.
Medicare Annual Enrollment runs October 15th through December 7th.
Healthcare Open Enrollment runs from November 1st through December 15th for plans starting January 1st. (Enrollment of Dec 16 through Jan 15 has a starting date of Feb 1st!)
Suzie and Matt have been assisting people understand and enroll in health insurance for over a decade in Wenatchee. They do not charge fees and answer questions throughout the year.
The Question: So, you’re still clocking in at the 9-to-5 grind, enjoying those free office donuts, and now, on top of that, Medicare is knocking on your door. You’re probably thinking, “Do I really need to enroll in Medicare while I’m still working?” Well, don’t worry—Suzie from Wenatchee Insurance has got your back, and she’s got answers that are as clear as a sunny day in North Central Washington!
1. Is Your Employer Big Enough to Be a Bouncer?
Large Employers (20 or more employees): If your employer is big enough to need name tags at the company picnic, they probably have a health plan that stays primary while Medicare takes a back seat. You can think of Medicare Part B as that friend who always offers to pay, but you don’t really need them to—yet. Suzie suggests you might want to grab Part A (it’s free, like a leftover doughnut in the break room), but hold off on Part B if you’re happy with your employer’s coverage.
Small Employers (fewer than 20 employees): If your employer is more like a cozy family reunion where everyone knows your middle name, then Medicare will want to be your primary insurance. Suzie says this is the time to roll out the red carpet for Medicare Part A and B, or you might find yourself stuck with some unexpected bills—like when you forget it’s your turn to bring snacks to the staff meeting.
HSAs and Medicare: A Tricky Tango: If you’re still playing the HSA game, you’ve got to be careful. Suzie warns that enrolling in Medicare will throw your HSA contributions out the window faster than your New Year’s resolutions. If you’re not ready to give up on that sweet, sweet HSA money, you might want to keep Medicare at bay for a little while longer.
3. Dodge the Medicare Penalty Like a Pro
Suzie’s Tip: If you think you’re too cool for Medicare Part B, think again! Suzie’s seen too many folks who thought they could outsmart the system, only to end up paying a penalty that follows them like a persistent telemarketer. So unless you’re into paying more for less, make sure you don’t miss that Special Enrollment Period (SEP).
4. Special Enrollment Period: Your Get-Out-of-Jail-Free Card
Still working and covered by your employer? Great news! Suzie says you’ve got a Special Enrollment Period to sign up for Medicare Part B whenever you’re ready—or within eight months after you finally decide to trade your desk job for a hammock. No penalty, no problem. It’s like finding out you don’t have to attend the annual budget meeting after all!
5. What About Part D?
Is Your Prescription Coverage Up to Snuff? If your employer’s prescription plan is as strong as the coffee in the break room, you can skip Part D for now. But if your plan’s looking a little weak, like the decaf everyone avoids, Suzie suggests enrolling in Part D to avoid any late penalties. Nobody likes paying extra, especially when that money could be spent on something important—like more office donuts.
In Summary: If you’re still working, it’s not a one-size-fits-all when it comes to Medicare. Suzie from Wenatchee Insurance is here to help you navigate the maze of Medicare decisions without breaking a sweat. Whether you’re working for a big corporation or a small business, Suzie’s got the advice you need to keep your coverage (and your sanity) in check. After all, the only thing more confusing than Medicare is trying to figure out who took the last donut!
Topics: health insurance, Medicare, Medicare Advantage, Home Insurance, Car Insurance, Business Insurance, Suzie, Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth, Quincy, Cashmere, Entiat,
Switching Medicare plans is like swapping seats at the Wenatchee Wild—you can do it, but you need to know when and where you’re allowed. Medicare gives you several chances to switch Medicare if your needs change, just like moving from the bleachers to next to the glass when the view isn’t quite right.
Suzie from Wenatchee Insurance is like a friendly usher who knows all the best seats.
During the Medicare Annual Enrollment Period (AEP) from October 15 to December 7, you can switch from Original Medicare to a Medicare Advantage plan, change your Medicare Advantage plan, or sign up for a Part D prescription drug plan.
During the AEP, you want to double-check your plan (ticket) to make sure that it is in the section that you want to be. You also get the chance to change the plan on your side kind of like upgrading your tickets to make sure you’re seeing the action from the best spot.
Medicare Advantage Open Enrollment Jan 1 -March 31
If you’re enrolled in a Medicare Advantage plan and decide it’s not for you, there’s also the Medicare Advantage Open Enrollment Period from January 1 to March 31. Suzie can help you switch back to Original Medicare or find a new Medicare Advantage plan during this time.
Special Enrollment Periods like losing a plan or moving
And if life throws you a curveball, like moving to a new area or losing other insurance, Suzie can check if you qualify for a Special Enrollment Period (SEP), giving you even more flexibility to switch medicare plans.
Suzie tip: We have another blog post that has a timeline for a Medicare Advantage plan leaving Washington State.
So, whether you’re looking for a better seat or just want to see the game from a new angle, Suzie will make sure you have the perfect Medicare plan to enjoy the show.
Suzie with Wenatchee Insurance has been helping people in Washington State navigate the twists and turns of Medicare for over a decade. If you have been a long-time resident, you may have encountered her when she was a Pharmacy Technician in Wenatchee. She has people who have set appointments years in advance to do the change from healthcare to Medicare.
Topics: health insurance, Medicare, Medicare Advantage, health alliance, wellcare, Molina, humana, Suzie, Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth, Quincy, Cashmere, Entiat, switch medicare,
We hear about medicare fraud more than we like. Suzie and Matt have been working with health and medicare insurance for over a decade in Washington State. In addition with Shayla we make up Wenatchee Insurance. We do not work for Medicare. Here is the disclaimer:
“We do not offer every plan available in your area. Currently, we represent 16 organizations which offer 62 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.”
Every agent is required to tell you a disclaimer and you will even see them on their websites. If you don’t receive one then you know that something strange is occuring.
Medicare Fraud does occur during the annual enrollment period.
The Medicare annual enrollment period runs October 15 through December 7 every year. It allows people with Medicare Prescription plans and Medicare Advantage plans to review and change plans every year. There is a lot of activity and chaos so we want to make sure that if you encounter anything strange that you can lend a hand in prevention. Having an appointment with an agent that you know can reduce the chance of fraud from occurring.
If you are not in our office in Wenatchee at 413 Mission Street then we are talking over the phone, it is on a recorded line. Medicare enrollments over the phone have been required for the last couple of years to be recorded. Yes, trained medicare agents record calls.
Medicare Fraud prevention tips
The Washington Office of the Insurance Commissioner has some great medicare fraud tips. The suggest checking the credentials when ever you have a question about who is selling you a medicare plan. We post copies of our licenses in our office lobby.
If you see Fraud then call 800-562-6900
When you report them. Let them know who they said they were and their phone number.
Suzie from Wenatchee Insurance— has seen this before. She can be your guide through the trails of Medicare Mountain. Suzie’s like the friendly tour guide; she has been trained about the ins and outs of Medicare and can make the whole experience as smooth as a glass of your favorite local vintage.
OK, storytime. You are strolling through one of the scenic vineyards near Lake Chelan sipping on a crisp glass of Riesling and enjoying the view. Life is pretty sweet, but you are getting close to 65, and suddenly, Medicare looms on the horizon like a far-off mountain range. You have had coverage for years from your job. What is this Medicare everyone’s talking about, and do you need to start climbing that mountain now?
Medicare 101
Medicare is a federal health insurance program designed primarily for people aged 65 and older, though younger folks with certain disabilities or conditions like End-Stage Renal Disease (ESRD) can also qualify. Think of Medicare as a big safety net, ensuring that as you transition into your golden years, you’re covered for hospital visits, doctor’s appointments, and other essential health services.
But wait—Medicare isn’t just one massive umbrella. It’s more like a series of cozy cabins at Mt Index’s Espresso Chalet, each with a different purpose:
Part A covers your hospital stays, kind of like the main lodge where you’ll spend most of your time resting and recovering.
Part B is your medical coverage, taking care of things like doctor visits and preventive services—think of it as your day trips around the area, keeping you in tip-top shape.
Part C (also known as Medicare Advantage) bundles Part A and B together with some extra perks, like dental and vision—imagine this as an all-inclusive spa package.
Part D is your prescription drug coverage, ensuring you have everything you need, from allergy meds to daily vitamins—like stocking up on brownies before taking a picture with Bigfoot.
Now, who gets to enjoy this Medicare experience? If you’re a U.S. citizen or legal resident who’s been living in the country for at least five years and you’re about to turn 65, congratulations—you’re eligible for Medicare! That is correct not everyone can get Medicare, you have to be eligible.
But Suzie knows that life isn’t always a straight path forward. Maybe you’re still working at the local apple orchard, or perhaps you’re basking in semi-retirement, splitting your time between Wenatchee and your cabin in Conconully. If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Parts A and B when you hit 65. Keep an eye on that mailbox. Otherwise, you’ll need to sign up during your Initial Enrollment Period (IEP)—a seven-month window that starts three months before your 65th birthday and ends three months after.
Suzie’s tip: Mark your calendar! Missing this window could mean penalties down the road, like forgetting to RSVP to that big community BBQ and getting stuck at the end of the line and getting the potato salad with raisons.
How Suzie Makes Medicare Fun
Suzie’s got your back, ensuring you’re not just surviving the Medicare process, but thriving. Picture this: It’s a sunny day in Wenatchee, and Suzie invites you to her office for a Medicare 101 session. She’s got a spread of local snacks—cheese from Walla Walla, apples from Stemilt Growers orchards, and we will skip the wine for the moment because we want to be clear-headed.
She’ll walk you through each part of Medicare, breaking down the insurance lingo into simple, easy-to-digest bites, just like that dutch apple pie you can’t resist. Maybe you’ve heard rumors that Medicare is complicated—like trying to figure out which trail to take on a hike through the Cascades. But with Suzie, it’s more like a leisurely stroll around town, where she points out all the highlights and makes sure you don’t miss a thing.
Need help choosing between Original Medicare and Medicare Advantage? Suzie’s got you covered, like marked-up trail map that shows you the best route based on your needs. She’ll make sure you’re not paying too much, missing out on any benefits, or accidentally wandering off the beaten path into a bears den in Leavenworth.
Wrapping Up the Medicare Adventure
By the end of your chat with Suzie, Medicare will seem less like a daunting mountain and more like a gentle, rolling pasture—beautiful, manageable, and maybe even enjoyable. So, when you’re ready to start your Medicare journey, remember that Suzie from Wenatchee Insurance is there to make it as delightful as a day spent exploring the best of Eastern Washington. Cheers to that!
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.
