Countdown Plan Year 2025 Healthcare ACAOpen Enrollment deadline:
01/15/2025
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Health Insurance
"66.5 percent of all bankruptcies were tied to medical issues—either because of high costs for care or time out of work." -CNBC, 11/11/2019
The Annual Open Enrollment for Healthcare Marketplace deadline is 1/15/2024.
*Andrew A Heron is a license health, life, and annuities broker licensed in the state of Florida.
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VSP Vision
✓ Lowest out-of-pocket costs in the industry
✓ $230 allowance for frames or contacts
✓ Quality comprehensive eye exam
✓ Low copays: $15/exam, $25/glasses
✓ The nation’s largest independent optometrist network.
✓ 1 in 4 Americans have VSP.
*See VSP brochure here.
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Health Insurance Glossary
Affordable Care Act - Often called “health care reform,” this is a 2010 federal law that changed certain rules regarding health insurance coverage in the United States. For example, key provisions to extend coverage to uninsured Americans and lower healthcare costs. Learn more at healthcare.gov.
Associated Costs - Costs that are related to a cancer diagnosis but not specifically due to medical care given to treat the disease; also called non-medical costs. Transportation and childcare during treatment are two common associated costs for people with cancer.
Authorization - Written approval from your insurance carrier to receive medical care at Moffitt Cancer Center.
Cancer Resource Services (CRS) - Cancer Resource Services (CRS) is a program provided by United Healthcare that offers United Healthcare patients access to a network of premier cancer centers. United Healthcare patients should call CRS at 866-936-6002 to verify eligibility for this specialized coverage.
Carrier - An insurance company that issues policies and makes payments to medical providers for its members.
Children’s Health Insurance Program (CHIP) - A medical coverage source for individuals under age 19 whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage.
Claim - A request made to an insurance company to pay for services covered by a patient’s policy.
Clinical trial - A research study to test a new treatment or drug.
Consolidated Omnibus Budget Reconciliation Act (COBRA) - A federal law that allows employees in danger of losing health insurance under certain circumstances, such as leaving a job or reducing their hours, to pay for and keep their insurance coverage for a limited time. Learn more at healthcare.gov/unemployed/cobra-coverage
Co-Insurance - The amount (usually a percentage) of the healthcare costs for which you have to pay. You pay co-insurance even if your deductible has been met. For example, you may pay 20 percent of the cost of medical services after meeting the deductible.
Co-Payment - A set fee, in dollars, that an insurance provider requires a patient to pay each time care is received. For example, a visit to the oncologist may cost a patient $30 each time; the insurance provider pays the rest of the visit's costs. The amount of the co-pay is set by the insurance provider, not the doctor's office.
Deductible - The amount of approved health care costs an insured patient must pay out-of-pocket each year before the health care plan begins paying any costs.
Disability insurance - Insurance that provides an income on either a short-term or a long-term basis to a person with a serious illness or injury that prevents the person from working.
Health Exchange - A key provision of the Affordable Care Act, established to provide a selection of competing health insurance providers, each offering different qualified plans. All qualified plans must meet standards established and enforced by the federal government. Learn more at healthcare.gov
Health Maintenance Organization (HMO) - A managed care plan that requires its members to use the services of their network of physicians, hospitals, or other healthcare providers. If you’re a member of an HMO, you are required to choose a primary care physician who must provide you with a referral to see a specialist.
In-Network - Physicians, hospitals, or other healthcare providers who have a managed care contract with your insurance plan. The fees of these providers are covered by the plan. You may still be responsible for a co-payment.
Indemnity Health Plans - Also called a fee-for-service plan. An insurance plan that allows you to see medical providers of your choice. You are responsible for paying a percentage of total charges no matter which medical provider you see.
Long-Term Disability (LTD) - Insurance (LTD) helps replace some of your income for an extended period when you cannot work at all or can only work part-time because of a disability. To be covered by LTD, you or your employer must pay a monthly premium.
Managed Care - An insurance plan that contracts with a network of healthcare providers. Your financial responsibility is significantly less when provided in-network. EPOs, HMOs, POS, and PPOs are managed care plans.
Medicaid - A state program that provides medical benefits to eligible people who have a low income level as well as to people with disabilities. Learn more at cms.gov
Medicare - A federal health insurance program that covers the cost of hospitalization, medical care, and some related services for people 65 years or older and for people with disabilities. Learn more at medicare.gov
Medigap Insurance - Extra health insurance that you buy from a private company to pay health care costs not covered by Original Medicare, such as co-payments, deductibles, and health care if you travel outside the U.S. Medigap policies don't cover long-term care, such as stays in a nursing facility, or dental care, and vision.
Network - A group of physicians, specialists, hospitals, outpatient centers, pharmacies, and other providers who has signed a contract with an insurance company to provide healthcare services to their subscribers.
Non-Covered Procedure or Service - A medical procedure or service that an insurance plan considers medically unnecessary (or experimental) and therefore does not cover.
Out-of-Network - Health care providers or facilities that are not part of an HMO or PPO plan's approved list or network are considered “out of network” (as opposed to being on an approved list or “in network”).
Out-of-network care often costs patients more than in-network care and may involve a deductible and require pre-approval for certain services.
Out-of-pocket Costs - Expenses that must be paid from a patient's personal financial resources; any expense not covered by insurance.
Patient Financial
Clearance Unit - A team available to assist with authorization requests, status of authorization and benefits eligibility. Contact Information
Point of Service (POS) - A health plan that contracts with a group of providers to offer medical services at discounted rates. When seeing an in-network specialist, such as an oncologist, you must obtain a referral from your primary care physician. POS plans allow you to seek care outside of the PPO network, but the insured party has a greater out-of-pocket expense.
Precertification - The process of requesting approval from an insurance plan for specific services before they happen, such as a treatment, procedure, or hospital stay; also called pre-approval. Many hospitals and clinics have precertification coordinators, patient navigators, or case managers who help patients with cancer through this process.
Preferred Provider Organization (PPO) - This is a type of private health insurance in which a person has access to a network of approved doctors, called in-network doctors. In PPOs, patients typically do not need a referral for specialist care.
Premium - The amount a person or company pays each month to keep insurance coverage.
Primary Care Physician (PCP) - A general or family practitioner who is your personal physician and first contact within a managed care system. The PCP will usually direct the course of your treatment and refer you to other doctors and/or specialists in the network if specialized care is needed.
Provider - Any medical professional (physician, nurse practitioner, etc.) or institution (hospital, clinic, etc.) that provides medical care.
Referral - In many managed care plans, you need to get a referral form before you get care from anyone except your primary care doctor. If you do not first get a referral, the plan may not pay for your care. Patients in HMO plans must also obtain authorization for treatment from the carrier prior to an appointment at an out-of-network facility.
Reasonable and customary fees - The average cost for health services in a geographic area that insurance plans use to decide how much they will pay for those services. If a doctor's fees for a service are higher than average, the patient must pay the difference.
Short Term Disability - Insurance can replace a portion of your income during the initial weeks of a disabling illness or accident. Policies can cover from the first 6 months up to a year of a disability, providing coverage during the waiting period of most Long Term Disability Insurance plans.
Specialist care - Healthcare given by a doctor who has been trained in treating a specific type of health problem or specific group of people. For instance, an oncologist is a doctor who specializes in treating cancer.
Supplemental insurance - A supplemental insurance policy helps cover expenses not covered by your primary insurance or the costs you pay as part of your existing plan. This policy generally covers deductibles, co-insurance, co-payments, and other out-of-pocket expenses. It may also offer additional benefits, such as compensation for lost earnings due to missed work.
Standard of Care - Items or services needed for reasonable and necessary care for diagnosis or treatment.
Virtual Visits - A virtual visit appointment can be a videoconference with your clinical care teams using a computer or a mobile device.
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Could guaranteed income from an income annuity fill the gap in, your retirement income?
Annuities and life insurance contracts
■ Not FDIC insured ■Not bank products ■May lose value ■Withdrawals prior to age 59 1/2 may be subject to tax penalty.
To your days in the sun!
Enjoy the security of annuity income!
Fixed, Equity Index, Income
Annuities
Exemption of cash surrender value of life insurance policies and annuity contracts from legal process.Exemption of cash surrender value of life insurance policies and annuity contracts from legal process.
Florida Statute 222.14
222.14 Exemption of cash surrender value of life insurance policies and annuity contracts from legal process.—The cash surrender values of life insurance policies issued upon the lives of citizens or residents of the state and the proceeds of annuity contracts issued to citizens or residents of the state, upon whatever form, shall not in any case be liable to attachment, garnishment or legal process in favor of any creditor of the person whose life is so insured or of any creditor of the person who is the beneficiary of such annuity contract, unless the insurance policy or annuity contract was effected for the benefit of such creditor.
Glossary of Long-Term Care
Glossary of Long-Term Care
Activities of Daily Living (ADLs) — Everyday functions and activities individuals usually do without help. ADL functions include bathing, continence, dressing, eating, toileting and transferring.
Assisted Living Facility — A residential living arrangement for people who may need assistance with one or more activities of daily living, but do not require the level of care provided in a nursing home. They can range from a small home to a large apartment-style complex. Services include laundry, meals, socialization and transportation in addition to personal care, medication management and memory care supervision and support.
Cancer — Also called malignancy, is characterized by an abnormal growth of cells. There are more than 100 types of cancer, including breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, and lymphoma. Cancer symptoms vary widely based on the type.
Cardiovascular Disease — Disease affecting the heart or blood vessels. Some conditions that fall under the umbrella of cardiovascular disease are aneurysm, angina, arrhythmia, cardiomyopathy, congenital cardiovascular defects, congenital heart disease, congestive heart failure, heart attack, diseases of pulmonary circulation, endocarditis, rheumatic fever, stroke, heart valve disease, diseases of the circulatory system.
Chronic Illness— A chronically ill individual is a person who has been certified by a licensed health care practitioner as being unable to perform, without assistance, at least two activities of daily living (ADLs) for at least 90 days, or has been certified to have cognitive impairment.
Cognitive Impairment— Requires substantial supervision due to a deficiency in a person’s short- or long-term memory; orientation as to person, place and time; deductive or abstract reasoning; or judgment as it relates to safety awareness.
High Blood Pressure — (Hypertension) Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers — for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high. The top number is your systolic pressure. It is considered high if it is over 140 most of the time. It is considered normal if it is below 120 most of the time. The bottom number is your diastolic pressure. It is considered high if it is over 90 most of the time. It is considered normal if it is below 80 most of the time.
High Cholesterol — is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. Primarily caused by diet and family history high cholesterol is defined as a measurement greater than 200 mg/dL. LDL cholesterol levels greater than 130 mg/dL and HDL cholesterol levels less than 60 mg/dL are considered high.
Home Health Aide – A trained and certified health care worker who provides personal care services such as bathing and dressing in addition to light household duties like meal preparation.
Home Health Care — Services for nursing care or occupational, physical, respiratory or speech therapy. Also included are medical, social worker, home health aide, and homemaker services
Licensed Practical Nurse (LPN) – A nurse who practices under the direction of a physician and cares for people who are sick, injured, in rehabilitation or disabled. Typically, an LPN has completed two years of specialized training and has passed a licensing exam.
Life Expectancy — The age which is calculated either actuarially, or manually, to estimate medical costs to.
Medicare — A federal system of health insurance for people over 65 years of age and for certain younger people with disabilities.
Medicare Part A — Hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.
Medicare Part B — Helps cover medically necessary services like doctors’ services, outpatient care, home health services, and other medical services.
Medicare Part D — Prescription drug coverage that is purchased through private insurance companies.
Medicare Premium — The amount of money a person pays to cover Medicare B, D, and Supplemental (MediGap).
Medicare Supplemental Insurance (MediGap) — Medicare Supplemental Insurance policies fill in the gaps that Medicare Parts A & B do not cover. This report assumes premiums for MediGap Plan G and uses the average cost for this plan in the subscriber’s state of residence.
Multiple Sclerosis — Multiple sclerosis is a nerve disorder that occurs when the insulating layer surrounding neurons in the brain and spinal cord are destroyed. The disease is a chronic autoimmune disorder that affects the movements, sensations, as well as body functions.
Myelin — a part of the brain, helps in passing electrical signals between the brain and the other parts of the body. When this part is destroyed the brain functioning is less efficient.
Nursing Home – A licensed facility that provides 24-hour room and board, plus general nursing care and personal care assistance to those who are chronically ill or unable to take care of daily living needs, or who need supervision and support due to a cognitive impairment. May also be referred to as a Long-Term Care Facility.
Premium — The amount of money needed to pay for insurance coverage. Before age 65 this would reflect a payment to a COBRA policy or an Insurance company. After age 65 the Medicare premiums would be reflected.
Registered Nurse (RN) – A specially-trained nurse who coordinates and provides patient care. RNs hold either a bachelor’s degree in nursing, an associate’s degree in nursing or a diploma from an approved nursing program and are licensed to practice by the state.
Retirement Age — The age at which each person plans to retire.
Skilled Care — Daily nursing and rehabilitative care that can be performed only by, or under the supervision of, skilled medical personnel. This care is usually needed 24 hours a day, must be ordered by a physician, and must follow a plan of care. Individuals usually get skilled care in a nursing home but may also receive it in other places.
Type 1 Diabetes — aka juvenile diabetes, or insulin-dependent diabetes, which is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. Various factors may contribute to type 1 diabetes, including genetics and exposure to certain viruses. Although type 1 diabetes typically appears during adolescence, it can develop at any age.
Type 2 Diabetes — (formerly called non-insulin dependent diabetes mellitus (NIDDM), or adult-onset diabetes) is a disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.
Types of Life Insurance
Equity Index Universal Life
Provides market-based tax-advantaged cash value accumulation with cash value protection that can supplement your retirement.
Accelerated Living Benefits
Access life insurance benefit during times of chronic, critical, or terminal illness may ease the financial burden during a stressful time.