Skip to content
Click to Call
Wenatchee Insurance Agency

413 N Mission St
Wenatchee, WA 98801

Get Directions

Featured Insurance Blog

What Is The Difference Between Orginal Medicare And Medicare Advantage?

Medicare Advantage Prescriptions talk to Suzie at Wenatchee Insurance

When it comes to choosing between Original Medicare and Medicare Advantage, it’s kind of like deciding between a road trip along Highway 97 or hopping on a Greyhound bus tour through Eastern Washington. Both will get you where you need to go, but the experience can be quite different.

Original Medicare, the trusty old Ford wood paneled Station wagon of the Medicare world, offers Parts A and B. It’s like cruising along the Columbia with the windows down 55 miles an hour —simple with no air conditioning. You get hospital coverage with Part A and medical insurance with Part B, but you’re pretty much on your own for extras like dental, vision, or hearing aids. (Yes, Medicare does not cover everything). And just like a road trip, if you want snacks or souvenirs (prescription drugs), you’ll have to plan ahead and get yourself a Part D plan. If you skip Plan D at the start of your Medicare trip then you may have a late enrollment penalty.  

Now, Medicare Advantage (Part C) is the private bus tour with the tinted windows. Suzie from Wenatchee Insurance can guide you through the process like your seasoned tour guide. Medicare Advantage plans are offered by private companies and bundle Parts A, B, and usually D together, plus extra perks like gym memberships (perfect for keeping fit while exploring the Cascades or checking out the local wineries). Suzie can help you pick a plan that stops at all your favorite sights, whether that’s routine checkups or specialty care.

So, whether you’re a solo adventurer or prefer the all-inclusive package, Suzie has you covered. Just give her a call, and she’ll help you figure out which route is best for your Medicare journey.

health or medicare enrollment suzie makes it easier

Topics: health insurance, Medicare, Medicare Advantage, Suzie,  Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth, Quincy, Cashmere, Entiat,

What medications are covered under medicare prescription Drug Plans?

prescriptions cost money a medicare plan d can save medicare prescription

Understanding Medicare Part D Coverage: A Hilarious Adventure with Wenatchee Insurance

Navigating which medications are covered under Medicare Prescription Drug Plans (Part D) can feel like deciphering an ancient scroll written in hieroglyphics. But fear not! Suzie & Wenatchee Insurance is here to turn this daunting task into a hilarious adventure that’s as enlightening as it is entertaining.

The Treasure Map: The Formulary

The formulary is your treasure map, showing you which medications are covered by your plan. Each plan has its own formulary, which can vary widely. It’s like a map with X’s marking the spots where your gold (meds) is hidden.

Sample: “Imagine being a pirate with a treasure map. Each X marks a spot where your treasure (medication) is hidden. Some maps are better than others, so choose wisely!”

The X Marks the Spot: Tiers of Medications

Medications in the formulary are divided into tiers, with each tier representing different levels of cost. Think of it as a hierarchy in a medieval kingdom.

Sample: “Tier 1 is the peasant tier—affordable and plentiful. Tier 2 is the knight tier—costs a bit more but offers more benefits. Tier 3 and beyond are the noble and royal tiers—high costs for high benefits. Choose your allegiance!”

health or medicare enrollment suzie makes it easier

The Scroll: Reading the Formulary

Understanding the formulary is like reading an ancient scroll. You’ll see medication names, tiers, and restrictions like prior authorization or step therapy.

Sample: “Deciphering the formulary is like reading an ancient scroll. Some words are clear, others require a magnifying glass and a translator. But don’t worry, we’re here to help!”

The Gatekeeper: Prior Authorization

Some medications require prior authorization, meaning your doctor needs to get approval before the plan covers the medication. It’s like asking the castle gatekeeper for permission to enter.

Sample: “Prior authorization is like asking the castle gatekeeper if you can enter. Sometimes they’ll wave you through, other times they’ll demand to see your credentials (doctor’s approval).”

The Quest: Step Therapy

Step therapy is a process where you must try cheaper medications before the plan covers more expensive ones. It’s a quest where you must complete tasks to progress.

Sample: “Step therapy is like a knight’s quest. You must complete the first task (try a cheaper med) before moving on to the next challenge (getting the expensive med covered).”

The Allies: Preferred Pharmacies

Some plans have preferred pharmacies where you can get your medications at lower costs. It’s like finding friendly allies in different towns during your journey.

Sample: “Preferred pharmacies are your allies in various towns. They offer you safe haven (lower costs) and help you on your quest (managing your meds).”

The Dragon: The Donut Hole

Ah, the donut hole—the fearsome dragon guarding the treasure. It’s a coverage gap where you pay more out-of-pocket for your medications. But with the right plan, you can slay the dragon and move forward.

Sample: “The donut hole is the dragon in your story—scary and expensive. But fear not, brave knight! With Wenatchee Insurance’s guidance, you can slay the dragon and continue your quest.”

calling suzie for medicare or health insurance help

The Ultimate Prize: Catastrophic Coverage

Finally, after navigating the formulary, prior authorization, step therapy, and the donut hole, you reach catastrophic coverage. It’s the ultimate prize where your costs decrease dramatically.

Sample: “Catastrophic coverage is the Holy Grail of your quest. After facing all the challenges, you find your costs reduced and your treasure (meds) more affordable. Victory!”

Wenatchee Insurance: Your Quest Companion

Understanding which medications are covered under Medicare Prescription Plan doesn’t have to be a solo quest through treacherous lands. With Wenatchee Insurance as your trusty companion, you’ll have a guide, map, and ally to help you every step of the way.

So, if you’re ready to embark on this epic adventure, let Wenatchee Insurance lead the way. Together, we’ll turn the daunting task of understanding Part D coverage into a thrilling, victorious quest.

We make quotes easy

How Do I avoid Late Enrollment Penalty for Medicare?

Medicare and Medicare Advantage help with suzie avoid late enrollment penalty

Avoiding Medicare late enrollment penalty is like making sure you’re not stuck in traffic on the George Sellar Bridge trying to pick up your kid at the mall—you want to plan so you don’t miss out (or have an upset kid!). The secret sauce is to sign up for Medicare on time, during your Initial Enrollment Period (IEP).

The Initial Enrollment Period is three months before your 65 Birthday, your Birth month, and then three months after your birthday. Seven months can seem like a long time but yes, we have encountered a fair number of people who have missed their IEP.

Suzie from Wenatchee Insurance is like your pocket navigator, guiding you to avoid any wrong turns. If you miss your IEP and don’t have other creditable coverage, you could face penalties when you enroll. The penalties do not go away and grow the longer you delay coverage.  

Late Enrollment Penalty Example

For example, for Part B, the late enrollment penalty is an extra 10% added to your monthly premium for each full 12-month period you were eligible for but didn’t sign up.

But here’s the fun part—Suzie trained to understand the shortcuts. Maybe you have employer coverage or are covered under a spouse’s plan? In these cases, you might qualify for a Special Enrollment Period (SEP), which is like getting a personal police escort across the bridge to make it on time.

health or medicare enrollment suzie makes it easier

Suzie can also help you figure out if delaying Medicare makes sense for your situation. Just like knowing when you can grab a coffee and when you need to get going, having Suzie’s advice will ensure you’re on time and on budget. For some people, it makes sense to start their Medicare Part A Coverage while others may want to delay their Part B.

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.

Home Health Medicare Car Dental Prescription insurance corndog

Topics: health insurance, Medicare, Medicare Advantage, wenatchee insurance, Suzie,  Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth, Quincy, Cashmere, Entiat,

Can Dreamers get health insurance in Washington state?

Dreams immigrant health washington suzie wenatchee

Who are Dreamers?

Today, Suzie & Matt are going to talk about Dreamers. The Deferred Action for Childhood Arrivals. The program was designed to provide temporary relief from deportation and allow people to legally work. There is about 16,030 Dreamers are in Washington State and there are probably more waiting.

Dreamer is not an easy process to achieve. There is an injunction in Southern District Court that prevents confirmation of new filings.  There is about another 100,000 applications in process. If you have not applied and meet the guidelines then filing could benefit you down the road

The website for U.S. Citizenship and Immigration Services goes into the details for Dreamer Status and has an online filing process. While we don’t do that at Wenatchee Insurance, we can talk about the insurance.

Immigrant Health in Washington

The important thing going on is the shift in Health Insurance for Immigrants.

In November 2023, Wenatchee Insurance started enrolling people into healthcare regardless of Immigration status. It is a great program that with a state-secure application grants access to the Healthplanfinder, Health Insurance, and monthly cost savings with tax credits.   

This was the largest group of uninsured in the state. They didn’t have access to a large group plan from an employer. They are students, stay-at-home parents, or even worked small businesses. At Wenatchee Insurance, we have advocated for immigrants to be covered for over a decade.

immigrant health washington wenatchee insurance

On July 1st, 2023, the Healthcare Authority Authorized the first 10,000 immigrants into the Apple Health Program. Those who were enrolled in other immigrant health programs or enrolled with a current plan went first and were under 158% of the poverty level. Yes, this is the regular Apple Health program level. It allowed people to get medical treatment and the providers to get paid promptly.

The next big change Dreamers:

CMS made a Final Rule in May to the definition of “lawfully present” for those who qualify for a health plan.  

If you are a Dreamer or a DACA recipient and other newly eligible individuals you will qualify for a Special Enrollment on November 1st, 2024, and have a plan on the Healthplanfinder starting as early as December 1st.

This will provide Dreamers access to Federal Advanced Premium Tax Credits which will lower their Healthcare costs further. If you have a current plan and are only using the state credits, then the application will have to be adjusted.

If you do not have health insurance, then we want to run the application, and you can have Healthcare before Christmas of 2024.

Set an appointment early as the Health Open Enrollment runs from  November 1st through December 15th for plans that start January 1st, 2025.

There is an additional enrollment period of December 15 through January 15 for plans starting February 1st.

How Much Does Dental Insurance Cost in Washington?

Dental Insurance Wenatchee

Alright, let’s talk about the million-dollar question—well, hopefully not literally. “How much does dental insurance cost?” It’s a question that keeps people in North Central Washington up at night, somewhere between worrying about deer in Grandma’s flower garden and whether The Wild will have a winning hockey season. At Wenatchee Insurance, we get it.

First things first: the monthly premium. This is the amount you’ll pay each month, kind of like your subscription to that jam-of-the-month club. Except this time, it’s your teeth getting the care they need. Depending on your plan, premiums can range from about $15 to $75 a month. It’s like choosing between the extra-large caramel apple from the Grant County fair or just a bag of organic Fuji apples—both will cost you, but which one will make you feel better about your choice? Freedom is important.

Deductibles and Co-Pays

Next, we have deductibles and co-pays. If you’ve ever had to pay to park at Leavenworth during Oktoberfest, you know what these are. A deductible is what you have to pay out-of-pocket first before your insurance kicks in, and co-pays are the little bits you pay each time you visit the dentist. Imagine going to the local cider mill and having to pay a few bucks just to get in—that’s your co-pay. Most deductibles range from $50 to $150 annually, while co-pays can be $10 to $20 per visit for most plans.

Delta Dental has options.
October is when we can offer next year’s plans.

Funny Example

Take our pal Farmer Fred from East Wenatchee. Farmer Fred figured he’d save some dough by skipping dental insurance altogether. After all, how bad could it be? Well, that was before Farmer Fred’s epic caramel apple incident last Halloween. One crack of that candy-coated delight and Farmer Fred was down two teeth and up several thousand dollars in dental bills. Now, Farmer Fred’s a dental insurance convert, paying his monthly premiums like clockwork, and sticking to softer treats—like apple pie.

Major Work: Crowns, Implants, and More Dental Insurance

For major work, the cost can be higher. We’re talking crowns, root canals, and implants—like if you decided to replace your old beater with a brand-new truck. The insurance might cover 50% to 80% of the cost after your deductible, leaving you to pick up the rest. These are the services that often have waiting periods. But trust us, it’s a lot better than footing the entire bill yourself.

Protip: Be aware of plan dollar maximums per person per year. This is the amount that the insurance plan will help with before wandering off to the next year. Some plans have them and some do not.

While we do a lot online at Wenatchee Insurance, we especially like to go over coverage with clients. We have some new clients that want to shop by brand name not realizing there can be significant differences for each product. We have encountered people who didn’t realize they had current coverage and others who did not know there was an add-on available from their insurance plan.

Topics: health insurance, Dental, Medicare, Implants, Braces, Bridge, Delta, Ameritas,  Dentures, Lifewise, Cavity, Suzie,  Chelan, Okanogan, Grant, Douglas, 509, Quincy, Cashmere, Entiat,

Home Health Medicare Car Dental Prescription insurance corndog

What Is the Medicare Annual Enrollment Period (AEP)?

Medicare Annual Enrollment Period Suzie Wenatchee

The Medicare Annual Enrollment Period (AEP) is like the annual Wenatchee Apple Blossom Festival—it’s the time when everything’s buzzing with excitement, and you have a chance to make important decisions. From October 15 to December 7, this is your window to review and make changes to your Medicare Prescription or Medicare Advantage Plan for the following year.

Picture this: you’re strolling through Memorial Park with your churro, and Suzie from Wenatchee Insurance is there with a booth set up to help you navigate your Medicare options. Maybe last year, you opted for a Medicare Advantage plan that looked great, like the shiniest red car in the Classy Chassis.  But now, you realize you need a plan with more prescription drug coverage, kind of like realizing you should’ve brought sunscreen before you went to Memorial Park for the Gyros and Funnel Cakes.

Why is the Annual Enrollment Period important?

During AEP, Suzie can help you switch plans or make tweaks to your existing coverage. Insurance Companies will update current clients by mail and release plans for the following year in October. It’s like picking out the best apples from a fresh batch—you want to make sure you’re getting the best fit for your needs.

Do not let the Medicare Annual Enrollment Period pass by like a clown in the parade—stop by Suzie’s booth (or give her a call) and make sure you’re set up for a healthy, happy year ahead.

If your plan is leaving then you may have a Special Enrollment Period.

Suzie has been assisting people in Washington state for over a decade selecting Medicare Prescription and Medicare Advantage Plans. She has people selecting her months in advance for these updates. If you do not see her available then call and we will do our best for a personalized appointment.

Topics: health insurance, Medicare, Medicare Advantage, Suzie,  Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth, Quincy, Cashmere, Entiat, Wenatchee Insurance,

What is the difference between insurance agent & insurance broker?

Insurance Broker Agent Producer

Is there a difference between Insurance Broker, Agent or Producer? What do I want when I shop for insurance for my home, car, health, or Medicare plan? How does it all work? Who is Wenatchee Insurance? Who are Matt, Shayla and Suzie?

Imagine you’re shopping for a pair of leather work boots.

Insurance Agent

Insurance Agent: This person works at a specific shoe store and will show you all the shoes they have in stock. They might have a great selection, but they can only offer you what’s in their store. If they are a Nike store then they will only sell you Nikes, if you are in a Converse store then they will only sell you Converse….you get the idea. In insurance terms, this agent represents one or a few insurance companies. They’ll help you pick the best shoe (policy) from what they have.

Insurance Broker

Insurance Broker: Now, think of this person as your very own shoe shopper. They don’t work for any specific store. Instead, they run around town, checking every store that they have access to find you the perfect pair of shoes at the best price. In the insurance world, a broker shops around with different insurance companies to find the best policy for you.

There is also a Surplus Lines Broker and that is a special license to sell products for carriers not admitted in our state. This would be like someone who could sell you a pair of $10,000 pair of Dolce & Gabbana when there were no stores in the state.

Insurance Producer

Insurance Producer: This is a fancy term that covers both agents and brokers. (It is the legal term in Washington State). If you’re a producer, you’re licensed to sell insurance, whether you’re helping people pick shoes from one store (agent) or shopping all over town (broker).

A Example:

Imagine you’re about to go on a hiking trip, and you realize you need a pair of sturdy hiking boots (let’s say the boots represent your insurance policy).

If you go to an Insurance Agent, they’ll show you all the boots they have in their store. “These are great boots!” they’ll say. And they are! But they’re the only ones they can sell you because that’s what their store offers.

If you go to an Insurance Broker, they’ll say, “Wait here!” and dash off to five different stores to find the best hiking boots in town. They might come back with three pairs and say, “Here, try these. They’re all great, but this one has the best grip, and it’s on sale!”

And if someone says they’re an Insurance Producer, they’re just telling you they can help you get insurance, whether they’re sticking to one store or shopping around.

So, next time you’re “shopping” for insurance in Washington State, now you know who does what—and who’s more like your personal shoe shopper!

Suzie health medicare Wenatchee insurance

So is Wenatchee Insurance Broker , Agents or Producers?

At Wenatchee Insurance we are Insurance Producers licensed in the state of Washington. We use exchanges to shop for products for our clients. We are contracted with many different companies for Health, Life, Travel, Medicare, Homes, Autos, and Businesses. We also work with several different brokers for additional support for our clients. We can recommend plans and do not add fees for our services.

Yes, we have been writing policies like Apple Health for clients for years without receiving a dime because it is the right thing to do for our community.

insurance bundle Wenatchee insurance

What is the Inflation Reduction Act doing to Medicare Prescription plans?

Medicare prescription plan d talk to Suzie at Wenatchee about Inflation Reduction Act

Suzie and Matt at Wenatchee Insurance have been discussing the upcoming changes for months. We view the Inflation Reduction Act as a creator of Big Changes in Medicare Prescription coverage. We see that resources will be limited during the Annual Enrollment Period. Consumers faced with large changes in Medicare Prescription Plans and Medicare Advantage plans looking for guidance for their plan update may feel pressured to take the first plan presented instead of thorough explanations of the updates.

Here’s a quick overview of how the Inflation Reduction Act (IRA) is changing Medicare:

Out-of-Pocket Spending Cap for Part D:

Beginning in 2025, the donut hole is gone. The Inflation Reduction Act introduces a $2,000 annual limit on out-of-pocket spending for Medicare Part D. This is a major difference. This maximum will protect Medicare beneficiaries from excessive drug costs and provide more predictable expenses throughout the year.

Medicare Prescription Payment Plan:

Also starting in 2025, the IRA will implement a new Medicare Prescription Payment Plan. It can be started anytime during the year. This plan allows Medicare beneficiaries to spread out their out-of-pocket costs for prescription drugs over the course of the year, instead of paying large sums all at once. This change aims to make managing drug costs more manageable for beneficiaries, especially those on fixed incomes.

For example, Farmer Fred uses Stelara for his arthritis. It retails for over $20,000 a dose on his Medicare Prescription Plan. It means that the first dose cost will stop at that out-of-pocket maximum and Farmer Fred can choose to make payments on the $2000 (out of pocket maxim remember) instead of everything up front like in previous years.

Medicare Prescription Drug Price Negotiation:

The IRA allows Medicare for the first time to negotiate prices for certain high-cost prescription drugs directly with pharmaceutical companies. The process began in 2023, with the first ten negotiated prices set to take effect in 2026.

The selected drug list for the first round of negotiation is:

Eliquis

Jardiance

Xarelto

Januvia

Farxiga

Entresto

Enbrel

Imbruvica

Stelara

Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill

The next round of fifteen drugs to be negotiated will be announced on February 1, 2025 and their new prices starting January 1, 2027.

health or medicare enrollment suzie makes it easier

Already in effect:

Capping Insulin Costs:

Starting in 2023, the IRA caps insulin costs for Medicare beneficiaries at $35 per month. This cap is expected to provide significant financial relief for those who depend on insulin to manage their diabetes.

Expanded Access to Vaccines:

The IRA ensures that all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are available to Medicare Part D beneficiaries with no cost-sharing, starting in 2023. This got vaccines like shingles to Medicare recipiants with no additional cost. The considerable list is here.

These changes reflect a significant effort to make healthcare more affordable and accessible for Medicare beneficiaries, particularly in the realm of prescription drugs.

In July the Centers for Medicare & Medicaid Services  released 2025 Medicare Part D Bid Information and Premium Stabilization Demonstration. For the Stand-alone Part D plans, they are going to provide some reassurance and work on lowering some of the forecasted costs. This stabilization has been done before. It was in the early days of the Medicare Part D plans. We will not be able to discuss the individual plan prices until October.

Suzie and Matt are recommending everyone with a Medicare Prescription Plan or a Medicare Advantage Plan with Prescriptions who want assistance double-checking plans to select an appointment now as there are millions of Americans with these plans and a limited number of people who are trained to assist.

Medicare Annual Enrollment Period runs from October 15th through December 7th.  

Home Health Medicare Car Dental Prescription insurance corndog

What advantage do you have in selecting a independent agency?

independent agency

Why Choosing Wenatchee Insurance as your independent agency is Like picking the Best Pot Belly Pig at the County Fair Imagine this: It’s a sunny day at the Douglas County Fair, and you’re trying to choose the best pig for the blue ribbon. You could wander around aimlessly, judging the contestants on your own, or you could ask Farmer Fred, the local pig expert, who knows every pig’s family tree and favorite mud wallow. Choosing insurance is a lot like that—except instead of pigs, it’s insurance policies, and instead of Farmer Fred, you’ve got Wenatchee Insurance. And let me tell y’all , that is some agency.

1. The Rodeo of Choices: Who Ya Gonna Call?

Y’all ever tried to read an insurance policy? It’s like trying to decipher a cow’s moo—confusing and a bit messy. Deductibles, premiums, and coverage limits make it sound like some kind of wild rodeo. Don’t get lathered up, because Wenatchee Insurance is like the best rodeo clown in the barrel, keeping you safe from all those wild terms and dangerous clauses. They know how to wrangle the best policies and lasso the right coverage for your needs. You just sit back, sip your iced tea, and watch them work their magic.

2. The Bargain Barn: Getting the Best Deals

Remember that time you found a deal so good it made you holler louder than the old rooster at sunrise? Well, that’s what working with Wenatchee Insurance feels like. They know the tricks of the trade, negotiating like a pro at a livestock auction. They’ll haggle, barter, and charm their way to get you the best deal possible, leaving you like a grinning possum eating tater tot casserole. You won’t have to fork out an arm and a leg to get the most bang for your buck.

3. Custom Fit: No cookie-cutter policies at an Independent Agency.

Finding the right insurance on your own is like trying to find the perfect pair of cowboy boots in a pile of mismatched shoes at the second-hand store. Wenatchee Insurance is like your personal bootmaker, hand-crafting a policy that fits just right and doesn’t pinch your big toe. Whether you’re protecting your homestead from bears, your prized miniature donkey or your little red wagon, they’ve got a plan that’s as comfy as grandma’s feather bed. No more one-size-fits-all nonsense; they’ll get you something that suits your needs like a perfectly tailored pair of Levis jeans.

custom fit insurance policy from your independent insurance agency

4. The Human Touch: Good Ol’ Country Hospitality

At Wenatchee Insurance, they treat you like family—just like a good neighbor who brings over an apple pie when you’re feeling blue. Got a question? They’re there with a smile and an answer, not some fancy-pants automated machine that leaves you shouting, “Representative!” They’re the friendly face you want by your side when things go haywire. Whether you need help filing a claim or just want to chat about the latest in tractor insurance, they’re ready with a warm greeting and a helping hand.

5. Saving Time: More Than Just Money in the Bank at an independent agency

Time is precious, like a cold drink on a hot day. Don’t waste it poring over confusing documents and trying to figure out what the heck “subrogation” means. Let Wenatchee Insurance do the heavy lifting. They’ll sort through the policies faster than a New York minute. You get to spend your time on more important things, like perfecting your chili recipe or finally learning to play that guitar.

So, why would you saddle up and go it alone in the Wild West of insurance? With Wenatchee Insurance as your trusty sidekick, you’ll get the perfect policy, the best deals, and the kind of service that’s finer than frog hair. It’s like winning the blue ribbon at the county fair—except you don’t have to wrestle any pigs!

Home Health Medicare Car Dental Prescription insurance corndog

Topics: Progressive, Farm, Fire Insurance, Home Insurance, Hobby Farm, Wenatchee Insurance, Chelan County, Grant County, Douglas County, Okanogan,

Five Things Original Medicare Does Not Cover

Medicare and Medicare Advantage help with suzie
Online, Phone or in person Suzie can help.

When it comes to health insurance for seniors, Original Medicare is a popular choice. Millions of Americans select it every year. It offers coverage for many essential health services. There are some gaps in coverage for Original Medicare that you need to be aware of.

Here are five key things that Original Medicare does not cover and some examples to help illustrate these gaps.

1. Routine Dental Care

Dental Care is one of the top requested needs. This can surprise many who planned on relying only on Medicare alone for their health insurance needs. Original Medicare does not cover routine dental care, including cleanings, gum scrapings, crowns, fillings, and dentures. Suzie has several different Dental Plans to fill in the gap.

Example:
Imagine you’re 70-year-old retiree, Mrs. Johnson. You notice some discomfort in your mouth after eating some Quincy Corn and decide to visit your dentist. After the exam, the dentist tells you a filling fell out and the pain is from a root canal you need. This painful surprise is out of pocket because Original Medicare doesn’t cover dental.

2. Vision Care

Original Medicare covers eye exams for people with diabetes and annual glaucoma tests for high-risk patients.  It does not cover routine eye exams or hardware like glasses or contact lenses. Are you sensing a trend for medical coverage from the shoulders up?

Example:
Mr. Thompson, an 68-year-old retired teacher, starts having trouble reading the Wenatchee World. He schedules an eye exam at the Vision Center at Confluence and discovers he needs an updated prescription. Mr Thompson is paying out of pocket for the exam and glasses because these are not covered by original Medicare.

3. Hearing Aids and Exams

Hearing loss is common among seniors, but Original Medicare does not cover hearing aids or the exams needed to fit them.

4. Long-Term Care

Original Medicare does cover skilled nursing facility care, but only for a limited time and under specific conditions. It doesn’t cover custodial care, which includes help with daily activities like bathing, dressing, and eating if that’s the only care you need.

Example:
Imagine you are Mrs. Rivera, 82, and living alone while your kids are living in Montana. After a fall, you find it difficult to manage daily tasks like bathing and dressing. You need long-term care to help with these activities. Unfortunately, Original Medicare does not cover this type of care. This expense is going to add up quickly.

5. Overseas Health Care

Original Medicare generally does not cover health care when you travel outside the United States. This can be a significant concern for those who love to travel or have family abroad. We had to start using a travel insurance exchange to provide options.

Example:
Mr. and Mrs. Davis, a retired couple, decide to take a dream safari to Africa. While abroad, Mrs. Davis falls ill and needs medical treatment. Since Original Medicare doesn’t cover international medical care, they face hefty medical bills, adding stress to what should have been a relaxing trip.

Insurance review are important

Getting Help with Coverage Gaps

Navigating the complexities of Medicare and understanding what it does and does not cover can be overwhelming. This is where Suzie with Wenatchee Insurance comes in. Suzie helps clients understand their Medicare options and then finds solutions to cover the gaps left by Original Medicare.

Suzie can help you explore Medicare Advantage plans, which often include additional benefits. These plans might also provide some coverage for long-term care and overseas health care. Additionally, Suzie can guide you through supplemental insurance options, known as Medigap policies, which can help cover some of the out-of-pocket costs not covered by Original Medicare.

Conclusion

Don’t let coverage gaps surprise you reach out and have a chat with Suzie today and ensure you have comprehensive health coverage for all stages of life. While Original Medicare provides valuable coverage, it’s crucial to be aware that it has limitations.

Routine dental care, vision care, hearing aids, long-term care, and overseas travel health care are significant areas where coverage gaps can occur.

By understanding these gaps and seeking assistance from professionals like Suzie at Wenatchee Insurance, you can find the right coverages to meet your needs.

health or medicare enrollment suzie makes it easier

Topics: Medicare, Original Medicare, Medicare Advantage, travel insurance, Cashmere, Wenatchee Insurance, Suzie, Enrollment, Glasses, Contacts, Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth

WE return calls & are here for appointments..OR you can start your free online quote now!

Compare Auto & Home Quotes
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

Partner Carriers

  • Allstate
  • Ambetter
  • American Collectors
  • American Modern
  • Bristol West
  • Burns & Wilcox
  • CHPW
  • Dairyland
  • Delta Dental
  • Encompass
  • Foremost
  • Guard
  • Hagerty
  • Humana
  • Lemonade
  • Liberty Mutual
  • Molina Healthcare
  • National General
  • Nationwide
  • Neptune Flood
  • Premera Blue Cross
  • Progressive
  • Propeller Bonds
  • Stillwater
  • The Hartford
  • Thimble
  • Travelers
  • Wellcare
  • Wright Flood