Are my doctors in network with my health insurance?

Posted on by Matt McColm
PPO or HMO how does your health plan work

At the Enrollment Center, we get asked a lot about networks from people wanting to understand their plans. There are a lot of assumptions about networks and this is intended to dispel some of those assumptions.

If you want assistance then let us know. It costs nothing to work with us.

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Domestic medical tourism refers to the practice where individuals travel within their own country to access medical treatments or healthcare services that are not available or are of a different quality or more affordable in another region or city within the United States. This can include a wide range of medical services, from major surgeries and specialized treatments to elective procedures and wellness services.

Key aspects of domestic medical tourism include:

  1. Accessibility of Specialized Care: Patients might travel to another part of the country to access specialized medical expertise and advanced treatment options that are not available in their local area.
  2. Avoiding Long Wait Times: In countries where healthcare systems face high demand, patients may face long wait times for certain procedures. Traveling to another region where the wait times are shorter can be an appealing option.
  3. Combining Treatment with Leisure: Some patients might combine their medical treatment with leisure activities, turning their medical trip into a more pleasant experience. This is particularly common in areas known for their natural beauty, cultural significance, or relaxation facilities.
  4. Quality of Care: Patients may perceive healthcare providers in certain cities or regions as being of higher quality than those available locally, prompting them to travel domestically for treatment.

Domestic medical tourism is influenced by factors such as the availability of healthcare services, the cost of care, the quality of facilities, and the reputation of medical practitioners in different regions of a country.

Domestic medical tourism has forced insurance companies to limit their networks to reduce provider costs. There has been a shift from the individual marketplace from Preferred Provider Organization (PPO) plans to Health Maintenance Organization (HMO) to Exclusive Provider Organization (EPO).

Every year during early summer, people have the right to make comments on the health plans during the public comment part of the plans.

It takes providers and insurance companies working together to build networks. Some options in Central Washington for Individual plans.

On our state’s exchange the Washington Healthplanfinder.

Want help in picking a plan? Here you go.

Coordinated Care Corporation/ Ambetter

Ambetter for 2024 Network. For a current list of network providers then please go to guide.ambetterhealth.com.

Networks in Washington State

Coordinated Care across the United States.

Community Health Plan of Washington

2024 Cascade Select Counties

In Wenatchee, the most popular clinic is Columbia Valley Community Health Service (CVCH) however there are over 21 Community Health Centers operating 200 Primary Clinics and over 70 Hospitals operating in the Community Health Plan of Washington‘s network.

Family Health Centers in Okanogan and Douglas Counties

Moses Lake Community Health Center in Moses Lake

New Health in Ferry, Pend Oreille, Spokane and Stevens Counties

Yakima Neighborhood Health Services and Yakima Valley Farm Workers in Yakima

Lifewise Health Plan of Washington

Lifewise has a variety of different levels, especially pay attention to the Cascade and Cascade Select plans as not every doctor is contracted with every Lifewise Network.

One of the Big advantages to Lifewise is the exclusive access to the Kinwell Clinics located throughout Washington State.

While domestic medical tourism has played a role in reshaping the Washington State Insurance and provider networks, we do have the ability with the three plans to travel to different parts of the state and still be with in network.

Please double check coverage prior to selecting a plan and prior to medical procedures as networks can shift with contracts.

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Topics: Healthplanfinder, Washington, Coordinated Care, Community Health, Lifewise, HMO, PPO, Medical Tourism, Hospital Networks,

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Yup, civilian healthcare is a bit of a mess.

Posted on by Matt McColm

Employers don’t have to offer health insurance. Some employers don’t. I have used the exchanges since I am self employed and there was a gap in coverage for my Veteran’s coverage.

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So you have people like me all over the United States helping match people with health insurance that works for their budget and their needs.

When and where to go?

The Open Enrollment Period for Healthcare is November 1st through December 15th.

For the United States, the main exchange is Healthcare.gov. If you have enough knowledge, then you can do it yourself or it can help you find someone to assist you.

I work in Washington state. Our state’s exchange is the Healthplanfinder.com. State Run exchanges can have extra benefits for example we get a bonus month for enrollments. My wife and I have been running one of the ten enrollment centers for the state which are located in Wenatchee. We have special rules in that we explain all of the plans on the exchange and are available year-round to assist and answer questions.

Who can help?

Check-in with your state resources and whenever possible use local resources. Health insurance plans are very regional like contracting down to the county level. There is a lot of disinformation out there as you work with more trained professionals the opportunity for understanding increases.

Just in case they need Medicare the Annual Enrollment Period is October 15th through December 7th. Yes, the overlap means that the people assisting people are incredibly busy.

Two groups that can be of further assistance:

  1. Medicare the State Health Insurance Assistance Program. These are volunteers they can explain however they cannot recommend or fill in any insurance gaps.
  2. National Association of Benefit and Insurance Professionals (NABIP). These are trained insurance professionals who can recommend plans and fill in protection gaps. If you local one then you are helping fund a small business.

Once you find a volunteer or broker that you connect with then do not hesitate to set an annual appointment early. Every year review your options and it will reduce surprises in the long run.

Outside of Open Enrollments, there are Special Enrollments

If you qualify for Medicaid or American Indian & Alaska Natives then you can enroll year-round. If you lose coverage or gain immigration status then you can use a special enrollment. Sometimes the state will declare a special enrollment for a disaster. Our office runs every application because special enrollments occur regularly and we want our clients to have the opportunity. If they miss it then they are set for the fall enrollment.

This year we had a large number of people setting appointments in September for their Fall appointments and they were able to spend minimal time waiting for an appointment or chasing a calendar space.

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Topics: Healthcare.gov, Healthplanfinder, Health Insurance, Medicare, ACA, Medicaid, SHIP, Enrollment Period, Washington, Wenatchee, Independent Insurance Agent,

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Four mistakes homeowners should avoid regarding flood insurance

Posted on by admin
flood home insurance wenatchee

Flood damage is one of the costliest types of home damage every year in the United States. That’s why it’s so important for homeowners in Wenatchee, WA to purchase flood insurance. At Wenatchee Insurance Agency, we offer flood insurance policies that can protect homeowners financially. 

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The following are four mistakes that homeowners need to avoid regarding flood insurance. 

Procrastinating before buying flood insurance

It’s never a good idea to wait before buying flood insurance. You never know when a flood could cause extensive damage to your home. Buy flood insurance now to ensure that you’re covered when disaster strikes. 

Neglecting to follow news about increasing flood risk in one’s area

You can’t assume that your area will never be at high risk of flood damage just because it wasn’t when you initially bought your home.

Flood zone maps can change due to community development projects and changes in regional weather patterns. That’s why it’s always important to follow local news on flood zone classifications. 

Overlooking details regarding basement coverage

Homeowners with basements need to pay attention to the fine print on their flood insurance policies. Some flood insurance policies limit coverage for basement areas of a home.

You cannot assume that a standard flood insurance policy will cover any basement damage that your home could experience. Basement coverage is an especially important policy detail for homeowners with finished basements. 

Relying on home insurance for flood damage coverage

One of the most important things homeowners should know about flood damage is that standard home insurance doesn’t cover floods. You need to invest in a separate flood insurance policy or add a flood coverage endorsement to your home insurance policy to get flood damage covered. 

Reach Out To Us

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When your home in Wenatchee, WA experiences flood damage, it’s essential for you to have a flood insurance provider you can rely on. Call us at Wenatchee Insurance Agency to get a quote on a flood insurance policy that will give you peace of mind and protect your home’s value. 

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What happens if my home is underinsured?

Posted on by Matt McColm

We like to do cost estimators on property prior to quote. It reduces the chance of a property being underinsured. This is especially problematic when rewriting older policies that have not been maintained and periods of high inflation.

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Forgive us as we show some math in this example.

Here we break down the example where your house is valued at $500,000, insured for $400,000, and incurs partial damage worth $50,000 in a fire:

  1. Policy Limit: Your insurance policy covers up to $400,000. This is the maximum amount the insurance company will pay in case of damage.
  2. Damage Assessment: The damage to your home is assessed at $50,000.
  3. Underinsurance Factor: Since your home is underinsured (it’s insured for $400,000 but is worth $500,000), you have only insured 80% of its value ($400,000/$500,000)×100=80($400,000/$500,000)×100=80.
  4. Claim Settlement: Insurance companies often use the “coinsurance clause” in such scenarios. This clause means that if you have not insured your property to at least a certain percentage of its value (often around 80-90%), the insurance company may reduce the payout for partial losses.

Let’s calculate the potential payout:

  1. If your policy has a coinsurance clause requiring at least 80% coverage, you are just at the threshold and your claim might be fully paid.
  2. However, if the requirement is higher than 80%, your claim payment could be reduced. For example, if the requirement is 90%, the calculation would be:

Claim Payment=Damage Amount×(Insurance CoverageRequired Coverage)Claim Payment=Damage Amount×(Required CoverageInsurance Coverage​)

So, it would be:

$50,000×($400,000$450,000(90% of $500,000))≈$44,444$50,000×($450,000(90% of $500,000)$400,000​)≈$44,444

This means you would receive about $44,444, and you’d have to cover the remaining $5,556 out of pocket.

  1. Out-of-Pocket Expenses: In the scenario where the full claim isn’t covered due to the coinsurance clause, you will need to pay the difference between the claim payment and the actual damage cost.
  2. Policy Review: This example highlights the importance of regularly reviewing your insurance coverage to ensure it matches the current value of your property, especially after significant changes in market value or property improvements. Having a conversation with your local independent agency can save a lot of headaches prior to claims.

The specifics can vary based on the terms of your insurance policy and local regulations, so it’s crucial to understand the details of your insurance coverage and any coinsurance requirements.

If it has been more than two presidents since you have talked with an Insurance Agent then we want to talk with you.

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Topics: Wenatchee Insurance, Chelan, Home Insurance, Fire Insurance, Claims, Coinsurance, Deductible, Independent Insurance Agent,  

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Contractors have special needs when it comes to insurance in Central Washington

Posted on by Matt McColm

As a contractor, it’s crucial to have insurance to protect your business from various risks.

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Here are seven types of insurance you should consider:

1. General Liability Insurance: This insurance provides coverage for damage or injuries that might occur due to your job. For instance, if you accidentally damage someone’s property while working, this insurance can pay for repairs. In Washington State, Labor, and Industries will want to have proof on file.

Link to L & I

2. Professional Liability Insurance: Also known as Completed Operations Coverage, this coverage protects you against claims where your work is alleged to have caused a financial loss. If a client claims that an error in your work caused them to lose money, professional liability insurance would cover your legal costs and any settlements.

3. Commercial Auto Insurance: If your business involves the use of vehicles, commercial auto insurance is necessary. This provides coverage for accidents, injuries, and property damage related to company-owned or leased vehicles.

4. Builders Risk Insurance: This insurance, also known as Course of Construction Insurance, provides coverage for the project itself from damage or loss due to events like fire, theft, or severe weather conditions. It can be done for new construction or a remodel job.

5. Tools and Equipment Insurance: This insurance covers the cost of repairing or replacing your equipment due to theft or unexpected breakdowns. It does not cover normal wear and tear.

6. Commercial Umbrella Insurance: This insurance provides an extra layer of protection beyond the limits of your other policies. If a claim exceeds the coverage limits of your other insurance, commercial umbrella insurance can cover the excess costs.

7. Surety Bonds: These act as a guarantee that you will fulfill the terms of your contract. If you fail to do so, the bond can pay to have the job completed. Some jobs will require additional bonds if you win the bid.

Get a Bond

Remember, the specific insurance requirements can vary depending on the nature of your work and where you operate. Therefore, it’s a good idea to consult with your independent insurance agent to ensure you have the right coverage.

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Topics: Contractor Insurance, Business Liability, Surety Bond, Builder’s Risk, Commercial Auto, Completed Operations, General Contractor, Sub, Handyman, LandI Labor and Industries, Tools and Equipment,

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What are the top 10 reasons to get life insurance

Posted on by Matt McColm

Does Medical Crowdfunding work? The American Journal of Public Health found that only 12% of medical GoFundMe campaigns reached their goals and a whopping 16% received no donations at all. Passing a hat to pay for expenses sucks and I would not wish that on anyone.

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Alternate to GoFundMe

Let’s keep it light. Here are the top 10 humorous reasons you might consider getting life insurance:

  1. Ghost Support: To make sure your ghost can haunt in style, with the latest ethereal gadgets like the “Boo-Bluetooth” or “Specter-Spectacles.”
  2. Debt Zombie Apocalypse: Life insurance helps ensure that your debts don’t rise from the grave to haunt your family, because the only thing worse than actual zombies is debt zombies.
  3. Funeral Extravaganza: So you can afford a funeral that’s less “sob and sniffle” and more “rock concert with pyrotechnics,” because you always wanted to go out with a bang!
  4. Mortgage-B-Gone Magic: Wave that wand and say goodbye to the mortgage! It’s the financial equivalent of a vanishing act for the ultimate peace of mind.
  5. Kid’s College Fund… or Bail Money: Whether it’s for their education or in case they take after your wild younger days, you’ve got it covered!
  6. Inheritance Roulette: Leave a game of financial Clue for your relatives. “I bequeath my collection of rare cheese labels to… the one who can stand on one leg the longest.”
  7. Guilt-Free Shopping Spree: Gives your partner the chance to indulge in retail therapy without the guilt, because “Honey, it’s what they would’ve wanted.”
  8. Secret Lair Maintenance Fund: Keeps your secret lair in tip-top condition for future generations of family super-villains or superheroes. Your kid could be Batman. Your legacy of mysterious hideouts lives on!
  9. The “I Told You So” Clause: For all the times you said you’d die before going to your in-laws’ house for dinner… and well, you want to be a person of your word.
  10. Santa Replacement Service: Ensures that Christmas remains a jolly affair with a professional Santa to fill your boots. Elves and reindeer rentals are, however, optional extras.

Remember, while it’s fun to add a touch of humor, life insurance is a serious matter that helps provide financial security for those you care about most! We will assist you along the way.

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Topics: Wenatchee Insurance, Life Insurance, Term Life, Whole Life, Family Planning, Final Expense, Health, Medicare, Chelan, Okanogan, Leavenworth, Liability,

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What are the benefits to Medicare?

Posted on by Matt McColm
Insurance Bundle

Medicare, since was signed into law on July 30, 1965, by President Lyndon B. Johnson, has had a profound impact on the health and well-being of seniors in the United States.

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Some of the major benefits include:

Improved Access to Healthcare: Prior to Medicare only a little over half aged 65 and older had some type of hospital coverage. There were numerous instances where private insurance companies were terminating health policies for aged persons in the high-risk category

Financial Protection: Before Medicare, healthcare expenses were a significant financial burden for many seniors. By providing coverage for various health services, Medicare has reduced the out-of-pocket medical expenses for seniors.

Increased Life Expectancy: Improved access to healthcare services and treatments through Medicare has contributed to increased life expectancy for seniors. We gained almost a decade of life expectancy.

Quality of Care: Over the years, Medicare has implemented various measures and initiatives aimed at improving the quality of care received by beneficiaries. By setting standards and promoting best practices, Medicare has influenced healthcare quality not just for its own beneficiaries, but for the entire U.S. healthcare system.

Shift to Preventive Care: Medicare has placed an emphasis on preventive services, offering screenings and tests at no or low cost. This not only helps in the early detection of diseases but also reduces the long-term costs of treating advanced diseases.

Support for Health Innovation: Medicare, due to its sheer size, has been at the forefront of various health policy innovations, from payment reforms to telehealth. Medicare Drug price negotiation has begun thanks to the Inflation Reduction Act.

Economic Impact: The introduction and expansion of Medicare influenced the medical profession, hospital expansions, the pharmaceutical industry, and other health-related sectors, leading to job creation and economic growth.

Improved Mental and Physical Health: Studies have shown that the establishment of Medicare was associated with improvements in the self-reported physical and mental health of older adults.

Summary

Medicare has played a crucial role in reshaping healthcare for seniors, providing them with improved access to medical services, financial protection, and better health outcomes. It’s evolved over time in response to various challenges and the changing needs of its beneficiaries. We look forward to seeing what Medicare does in the future.

It is why we recommend our clients check in at least once a year to see if any updates can benefit them. The Medicare Annual Enrollment period runs from October 15th through December 7th of each year.

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Medicare part A, Part B, Part C and Part D

Topics: Health Insurance, Medicare, Wenatchee Insurance, Enrollment Center, Healthplanfinder, Affordable Care Act, ACA, Obamacare, Prescription Drugs, Medicare Advantage Plan, Medigap, Health Alliance, Wenatchee, Washington State, Chelan,

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What does event insurance cover?

Posted on by Matt McColm

Event insurance is important for several reasons, providing protection and peace of mind for both event organizers and attendees. Here are some of the primary reasons why event insurance is considered crucial:

  1. Protection Against Financial Loss: Organizing an event often involves significant costs such as venue rental, equipment hire, catering, entertainment, and advertising. If the event is canceled or interrupted due to unforeseen circumstances, event insurance can cover the non-refundable expenses and financial losses incurred.
  2. Liability Coverage: Accidents can happen at any event, whether it’s someone slipping on a wet floor, food poisoning from catered meals, or equipment malfunctioning. Liability insurance protects the event organizer from potential lawsuits and claims arising from bodily injuries or property damage that might occur during the event.
  3. Venue Requirement: Many venues require event organizers to have liability insurance as a condition for renting their space. This is a common request from companies renting space for events. We just have to know who has to be listed on the Certificate of Insurance.
  4. Protects Against Non-Appearance: If a key speaker, performer, or celebrity fails to attend, this could lead to significant losses, especially if ticket sales were dependent on their appearance. Certain insurance policies can cover losses in these situations.
  5. Coverage for Vendors: If a vendor fails to deliver, goes out of business, or does not meet contractual obligations, the event organizer could face additional unexpected costs. Insurance can provide compensation in these situations.
  6. Property Damage: Insurance can cover damage to or theft of property rented or owned by the event organizer, such as audio-visual equipment, tents, or decorations.
  7. Liquor Liability: If alcohol is served at an event, liquor liability insurance protects the event organizer if attendees cause harm or damage after consuming alcohol provided at the event.
  8. Tailored Coverage: Event insurance can be tailored to the specific needs of an event. Whether it’s a small party, a corporate seminar, a large festival, or a wedding, policies can be adjusted to suit the particular risks and scale of the event.

In essence, while no one wants to think about the things that could go wrong during an event, it’s prudent to be prepared. Event insurance offers that layer of protection and ensures that unforeseen circumstances do not lead to crippling financial losses.

Topics: Event Insurance, Liability, Vendors, Liquor Liability, Property Damage, Host, Food Poisoning, Chelan, Host, Wenatchee Insurance, Cashmere, Mercantile, New Years Party, Christmas

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How much does Medicare Cost

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

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

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

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

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

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

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

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

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

Topics: Health Insurance, Medicare, Wenatchee Insurance, Enrollment Center, Healthplanfinder, Affordable Care Act, ACA, Obamacare, Prescription Drugs, Medicare Advantage Plan, Medigap, Health Alliance, Wenatchee, Washington State

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What does a health insurance plan cover in Washington State?

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

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

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

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

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

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

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

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

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