{"id":1556,"date":"2025-12-15T09:00:00","date_gmt":"2025-12-15T10:00:00","guid":{"rendered":"http:\/\/www.dangeladvertising.com\/?p=1556"},"modified":"2025-12-19T15:04:56","modified_gmt":"2025-12-19T15:04:56","slug":"an-arm-and-a-leg-how-to-pick-health-insurance-in-the-worst-year-ever","status":"publish","type":"post","link":"http:\/\/www.dangeladvertising.com\/index.php\/2025\/12\/15\/an-arm-and-a-leg-how-to-pick-health-insurance-in-the-worst-year-ever\/","title":{"rendered":"An Arm and a Leg: How To Pick Health Insurance \u2014 In the Worst Year Ever"},"content":{"rendered":"

As health insurance premiums skyrocket in both employer-based plans and Affordable Care Act marketplaces, millions face worse choices than ever during this open enrollment.<\/p>\n

The team behind \u201cAn Arm and a Leg\u201d examines their own limited options, walking through how they approached reading the fine print to weed out the worst choices \u2014 and potentially save thousands of dollars.<\/p>\n

Plus, KFF Health News senior correspondent Julie Appleby explains what could happen if Congress changes course and extends the enhanced premium tax credits for Obamacare enrollees that are due to expire at the end of the year. And a listener wonders: Is paying for health insurance even worth it at this point?<\/p>\n

\tDan Weissmann<\/p>\n

\t\t\t
\n\t\t\t\t@danweissmann\t\t\t<\/a><\/p>\n

\t\t\tHost and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.\t\t<\/p>\n

\n\t\tCredits\t<\/h3>\n

\tEmily Pisacreta
\n\tProducer<\/p>\n

\tClaire Davenport
\n\tProducer<\/p>\n

\tAdam Raymonda
\n\tAudio wizard<\/p>\n

\tEllen Weiss
\n\tEditor<\/p>\n

\t\t\t\t\tClick to open the Transcript\t\t\t\t<\/p>\n

\t\t\t\t\t\tTranscript<\/strong>: How to pick health insurance \u2014 in the worst year ever<\/strong>\t\t\t\t<\/p>\n

Note: \u201cAn Arm and a Leg\u201d uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.<\/em><\/p>\n

Dan hosting:<\/strong> Hey there. As we started writing up this episode, the U.S. government was starting to re-open, after the longest shutdown ever. ?Eight Democratic Senators had made a deal.<\/p>\n

News anchor: But this deal has Democrats divided. It does not include an extension for Obamacare subsidies, which is what the party was holding out for.<\/strong><\/p>\n

Dan hosting:<\/strong> And people were pissed. Here\u2019s a couple examples from our social-media feeds\u2026\u00a0<\/p>\n

TikTok user hunteralexanderpowell: eight Democrats caved and betrayed the American people tonight<\/strong><\/p>\n

TikTok user shaneechchi: The Democrats caved. The Democrats caved! What? I have tried to calm down so many times to record this video, but Senate Democrats\u2026<\/strong><\/p>\n

Dan hosting:<\/strong> Those Democrats did extract one sliver of a concession: A promise from Republican Senate Majority Leader John Thune to schedule a vote on extending the subsidies for early December. Which lots of people found\u2026 unsatisfying. One more from our feed here. There\u2019s some strong language in this one:\u00a0<\/p>\n

TikTok user 2rawtooreel: After 40 days of fighting for our subsidies, we got a pinky promise. What a gut punch. The eight Dems caved and then they fucked our families. And that\u2019s the way they all became the bitch-ass bunch. The bitch-ass bunch.<\/strong><\/p>\n

Dan hosting:<\/strong> Yeah. News reports pretty much all say: That vote will fail.<\/p>\n

But even if they\u2019re wrong, even if some unexpected deal gets made, expect nightmares. Logistical nightmares. Tech nightmares. Julie Appleby is a reporter with our pals at KFF Health News.<\/p>\n

She talked to folks who run the Obamacare exchanges in a bunch of states and asked them: Hey, if Congress makes a deal, what happens next?<\/p>\n

They were like: Well, we\u2019d have to take our websites down to plug in the new numbers.\u00a0<\/p>\n

Julie Appleby: And that could take maybe up to a week.<\/strong><\/p>\n

Dan:<\/strong> Yeah, a week. Julie says that took her by surprise.<\/p>\n

Julie Appleby: I guess I mistakenly assumed, naively assumed that, oh, it\u2019d be pretty easy. Let\u2019s just, you know, program these numbers in. It might take a couple hours or whatever, but no, it\u2019s not just a simple let\u2019s throw a switch and change all this stuff\u2026<\/strong><\/p>\n

Dan hosting:<\/strong> And there\u2019s a ticking clock: If you want an Obamacare plan that starts covering you on January first, you have to sign up by\u2026 December 15. And again, IF there\u2019s a vote to do any of this, it\u2019s not supposed to happen until December. Tick-tock\u2026\u00a0<\/p>\n

So look: Nobody can predict the future, but if you\u2019re looking at Obamacare for 2026: Don\u2019t count on those extra subsidies being there.<\/p>\n

Meanwhile, premiums are going up \u2014 both for Obamacare plans and for employer-based insurance.<\/p>\n

We\u2019re gonna spend the rest of this episode looking at: OK, now what? It\u2019s the worst ever year to choose insurance. What do you do? We\u2019ll hear from a listener who wrote to us asking for advice, and we\u2019ll look at what next year looks like for ourselves \u2014 for me and my colleague Emily Pisacreta.\u00a0<\/p>\n

There are folks who have it worse than we do. Millions of people just won\u2019t be able to afford insurance at all for next year. But our stories give a sketch, a little sample \u2014 and some lessons and tools that I hope will come in handy for anyone asking the same questions we are.<\/p>\n

Like a lot of our stories \u2014 like our whole beat\u2013 there\u2019s no happy ending here. This absolutely sucks.<\/p>\n

We\u2019re talking about choosing the LEAST crappy option here. Which, even when all the options are crap, is STILL WORTH DOING. Because some options are so much crappier than others. But sorting out which ones means learning to read some fine print. So let\u2019s get to it.<\/p>\n

This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it. I\u2019m Dan Weissmann. I\u2019m a reporter, and I like a challenge. So the job we\u2019ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life, and bring you a show that\u2019s entertaining, empowering, and useful.<\/p>\n

Let\u2019s pick up where we left off a couple of months ago: With this show\u2019s senior producer, Emily Pisacreta.\u00a0<\/p>\n

Dan hosting:<\/strong> Hey Emily.<\/p>\n

Emily hosting: <\/strong>Hey Dan.<\/p>\n

Dan hosting:<\/strong> So, let\u2019s recap\u2026\u00a0<\/p>\n

Emily hosting:<\/strong> Yeah, so before\u2026 I had insurance from another part-time job. But that job ended over the summer.<\/p>\n

Dan hosting:<\/strong> And An Arm and a Leg has always been so tiny, I never thought about budgeting for anybody else\u2019s health insurance.<\/p>\n

Emily hosting:<\/strong> So I had to look for Obamacare. And I ended up getting help from the absolute best person: Elisabeth Benjamin. She\u2019s Vice President of Health Initiatives at the Community Service Society of New York.\u00a0<\/p>\n

Dan hosting:<\/strong> She has been one of our go-to sources for years\u2013\u00a0 because her fights to protect New Yorkers from medical debt are epic.<\/p>\n

Emily hosting :<\/strong> And as it happens, she\u2019s also a navigator for Obamacare \u2014 she helps people choose and sign up. She invited me over to look at my options.<\/p>\n

Elisabeth Benjamin: Ok, so ready?\u2026<\/strong><\/p>\n

Emily hosting:<\/strong> The good news: I qualified for a subsidy.<\/p>\n

The bad news: That was gonna come to a screeching halt come January. She suggested we meet again in November to look at my 2026 options.<\/p>\n

So, last week, we did\u2013 just a couple days after those Senate Democrats had folded on the enhanced subsidies.\u00a0<\/p>\n

Elisabeth Benjamin: It\u2019s quite clear that the enhanced premium tax credits are gonna sunset. Right?<\/strong><\/p>\n

Emily: Yeah.<\/strong><\/p>\n

Elisabeth Benjamin: Yeah. Which is really horrible for patients.<\/strong><\/p>\n

Emily: Are you surprised or did you sort of see the writing on the wall?<\/strong><\/p>\n

Elisabeth Benjamin: I find understanding Congress and the federal government and what they\u2019re gonna do really challenging. I would\u2019ve thought people would\u2019ve wanted to do something, but it\u2019s, it\u2019s hard when people aren\u2019t getting SNAP benefits and planes aren\u2019t flying. And for me I would\u2019ve thought that they would\u2019ve been able to come up with a compromise, but they didn\u2019t. So\u2026<\/strong><\/p>\n

Emily: Yeah.\u00a0<\/strong><\/p>\n

Elisabeth Benjamin: So, you know, I don\u2019t know. All right. Lemme show you your thing.\u00a0<\/strong><\/p>\n

Emily: You wanna share your screen?\u00a0<\/strong><\/p>\n

Elisabeth Benjamin: Okay. Um, so here\u2019s your account. Here\u2019s your eligibility. You know, this is what you have right now. Your tax credit is $385 a month. Your income, if it\u2019s unchanged, means you will be eligible for no tax credit next year.<\/strong><\/p>\n

Emily hosting:<\/strong> So we kinda knew this was coming. I make a little more than 400 percent of the federal poverty level, which means I don\u2019t qualify for that enhanced premium tax credit anymore.\u00a0<\/p>\n

Elisabeth Benjamin: You are being impacted by the expiration, like you are going from. Spending whatever it was, 400, $400 a month to $800 a month.<\/strong><\/p>\n

Emily hosting:<\/strong> Actually it\u2019s going from $496 to $867. And all this for what\u2019s called a Silver Plan. You know, not platinum, not gold.\u00a0<\/p>\n

Elisabeth Benjamin: You\u2019re not talking about Cadillac coverage here. You have a big deductible.<\/strong><\/p>\n

Emily hosting:<\/strong> Yeah\u2026 that\u2019s $2500 before I can afford to see a doctor in person. A doctor who\u2019s in-network. In an itty bitty network. I kinda wondered what I would get if I leveled up.\u00a0<\/p>\n

Elisabeth Benjamin: So you wanna do the cheapest gold or like a mid price<\/strong><\/p>\n

Emily: Yeah. Let\u2019s just see what the cheapest golds look like.<\/strong><\/p>\n

Elisabeth Benjamin: So the cheapest is 1100. $1,100. So that\u2019s a lot.\u00a0<\/strong><\/p>\n

Emily hosting:<\/strong> Yeah so that was out of the question. And we looked at a slightly cheaper silver plan, too. But the deductible was a lot higher and the ER coverage was pitiful.<\/p>\n

Elisabeth Benjamin: Just walking into an emergency room in New York City is like $10,000. So you\u2019d be basically paying your whole emergency room visit. Whereas right now you have real protection, you only have $500\u2026<\/strong><\/p>\n

Emily hosting:<\/strong> And anyway for all its holes, my current plan \u2014 like of these New York state marketplace plans \u2014 does actually have a big advantage over every other health insurance plan I\u2019ve ever had. Zero dollar copays for my absolute do or die stuff \u2014 my insulin and my continuous glucose monitor.<\/p>\n

Dan hosting:<\/strong> Yeah. That\u2019s just one way where you live really matters.<\/p>\n

Emily hosting:<\/strong> Yeah and I\u2019m never leaving, I\u2019m like the worst kind of New York chauvinist. But the cost of living here means this premium increase is gonna really hurt. I\u2019m gonna need another job.<\/p>\n

Dan hosting:<\/strong> Yeah, but I wanna keep you in this one. And we are working on a plan there. We\u2019ll come back to it later.\u00a0<\/p>\n

Emily hosting:<\/strong> Mmhm.<\/p>\n

Dan hosting: <\/strong>Meanwhile, you\u2019ve given us a snapshot of Obamacare.<\/p>\n

Obamacare plans aren\u2019t the only place where costs are going up. According to a survey of 1,700 businesses, the rate hikes on employer plans are the biggest in 15 years.<\/p>\n

And you know who\u2019s on an employer plan? My family. My wife and I both have small little businesses, and we\u2019ve been able to buy small-group coverage for ourselves that way \u2014 which means we do get to choose from plans that aren\u2019t on the Obamacare exchange.\u00a0<\/p>\n

So, here\u2019s a little heartwarming scene from my house \u2014 me showing my wife Devorah what our health insurance is going to cost for next year.<\/p>\n

Devo: All right.<\/strong><\/p>\n

Dan: Make sure we\u2019re recording. Let\u2019s see. Yep. Here we go. Alright, so let me just show you what I have been looking at.\u00a0<\/strong><\/p>\n

Devo: Alright.<\/strong><\/p>\n

Dan:\u00a0 And be aware that it super sucks.\u00a0<\/strong><\/p>\n

Devo: Alright.<\/strong><\/p>\n

Dan hosting:<\/strong> And here\u2019s what I showed her: Our insurance plan is going up by 500 dollars a month in January. Six thousand dollars a year.\u00a0<\/p>\n

Devo: I\u2019m not allowed to say bad words, right?\u00a0<\/strong><\/p>\n

Dan: You\u2019re totally allowed to say, are you kidding me? Bad words are very appropriate.\u00a0<\/strong><\/p>\n

Devo: Bad words are forming in the thought bubble over my head.\u00a0<\/strong><\/p>\n

Dan: You can say them all you want\u00a0<\/strong><\/p>\n

Devo: Okay. Fuck.\u00a0<\/strong><\/p>\n

Dan hosting:<\/strong> Absolutely fair. The new total for our plan is terrifying.. And \u2014 for reasons I\u2019ll get to \u2014 that plan still looks like our best option.<\/p>\n

Meanwhile, we\u2019d heard from a listener \u2014 Jess lives in Indiana. She asked us to just use her first name, to protect her family\u2019s privacy.<\/p>\n

And she wrote to ask: Have you ever done a show about whether having health insurance is even worth it? A perfectly understandable question. We talked in early November.<\/p>\n

Jess: Does it ever make sense to just, if you feel relatively healthy, like if I take what I\u2019m paying for a premium and put into the bank account is, does that make more sense than just giving over this huge percentage of money? It feels like there\u2019s not an answer.<\/strong><\/p>\n

Dan hosting:<\/strong> In her case, it looked like insurance for her and her husband would go up a couple hundred bucks a month, for the same crummy, bare-bones plan they already have. That could still leave them on the hook for like 17 thousand dollars in medical bills.<\/p>\n

Jess: Obviously I feel really lucky that like we don\u2019t work through the federal government or any number of folks who are dealing with much more this year than we are. But then at the end of the day, it\u2019s really hard to press the button, and sign up for something that you\u2019re like, well, I know I\u2019m not gonna get great care because the one plan I chose like really limits the amount of doctors I can go to.<\/strong><\/p>\n

Dan hosting:<\/strong> And she says that limited list of doctors, it\u2019s got a lot of turnover.<\/p>\n

Jess: So like, we\u2019ve been through how many doctors in the past five years? Then I know that if anything bad does actually happen, I still gotta come up with like $17,000 to like pay those bills, on top of everything else. So sometimes I\u2019m just wondering like where, like with a system that doesn\u2019t make any sense, where\u2019s the line where for\u2026 I just feel like a lot of people are gonna be thinking about this, this year. Like, what? I\u2019m gonna keep the money, I\u2019m gonna put it in the bank and with people losing their jobs and stuff too, like maybe it\u2019s time to just bulk up your savings. I don\u2019t know.<\/strong><\/p>\n

Dan hosting:<\/strong> Jess and her husband run a small business. It hasn\u2019t been a great year, and next year could be kind of dicey. On the other hand, her dad survived a major bout with cancer earlier this year. That experience had already been noodging her toward pressing the button: paying the extra for insurance. And then a little after she wrote to me.\u00a0\u00a0<\/p>\n

Jess: I was like visiting dad, this fall, So it had been long enough that he actually got the like ex\u2013 like I think it\u2019s probably the explanation of benefits or whatever\u2026<\/strong><\/p>\n

Dan hosting:<\/strong> Yep, explanation of benefits: That\u2019s the insurance paperwork that shows the total chargesfor all that cancer treatment, and what the insurance company paid.<\/p>\n

Jess: And he\u2019s like, do you wanna know how much that cost? it was a million dollars. And I was like, okay, I guess I\u2019m getting health insurance again this year.\u00a0<\/strong><\/p>\n

Dan: Oh my God. Wow.<\/strong><\/p>\n

Dan hosting: <\/strong>She and her husband *can* find the extra couple hundred dollars a month. And they will. But it still feels unresolved.\u00a0<\/p>\n

Jess: I really love, like really trying to understand a problem I\u2019m trying to solve and making sure I\u2019ve like, I feel like that\u2019s the, that\u2019s the hard thing with this is that like every year I\u2019m like, have I thought of everything?<\/strong><\/p>\n

Have I considered all the parameters? Have I I done the right research?<\/strong><\/p>\n

And just kind of feeling like on your own with it, even though, you know, everyone\u2019s going through the same thing.<\/strong><\/p>\n

Dan: For sure. For sure.<\/strong><\/p>\n

Jess: It sucks.<\/strong><\/p>\n

Dan hosting:<\/strong> Here\u2019s what\u2019s coming next:\u00a0<\/p>\n

We\u2019re gonna come back to Emily\u2019s story\u2013 and mine. There\u2019s a POSSIBLE less-sucky option for Emily \u2014 it\u2019s gonna take some doing \u2014 and in every case:\u00a0<\/p>\n

We\u2019re looking closely at the options we DO have. Going through all that paperwork is not fun, but the details we found buried there are gonna make a HUGE difference\u00a0\u00a0<\/p>\n

We knew where to find them because we\u2019ve been doing this \u2014 looking at the puzzle of shopping for health insurance \u2014 for a lot of years now.\u00a0<\/p>\n

We\u2019ll walk you through some of what we did, and recap some of what we\u2019ve learned over all this time.<\/p>\n

That\u2019s coming right up.<\/p>\n

This episode of An Arm and a Leg is produced in partnership with KFF Health News \u2014 that\u2019s a nonprofit newsroom covering health issues in America. These folks are incredible journalists \u2014 their work wins all kinds of awards, every year. We are honored to work with them.<\/p>\n

Let\u2019s go back to my house for starters. As you may recall, our plan for next year is gonna cost about 500 dollars more every month. That\u2019s 6 thousand dollars for the year.<\/p>\n

And Devorah and I were processing.<\/p>\n

Devo: I mean\u2026\u00a0<\/strong><\/p>\n

Dan: It\u2019s a lot.<\/strong><\/p>\n

Devo: That\u2019s a lot of money.\u00a0<\/strong><\/p>\n

Dan: It\u2019s a lot of money.\u00a0<\/strong><\/p>\n

Devo: And that\u2019s just like additional money. Like we\u2019re already hemorrhaging money on health insurance, like before it goes up $6,000.\u00a0<\/strong><\/p>\n

Dan: Right? Right. We\u2019re already paying a lot. We\u2019re already paying a lot, and so we\u2019re looking at adding $6,000 to that and\u2026\u00a0<\/strong><\/p>\n

Devo: Can I have a different timeline?<\/strong><\/p>\n

Dan: Yeah, we\u2019d all like that. Right now there are alternatives. Um, they\u2019re not great.\u00a0<\/strong><\/p>\n

Devo: Okay.\u00a0<\/strong><\/p>\n

Dan hosting:<\/strong> Our broker had sent us a couple other plans to look at. And they were a little less: Instead of 2600 dollars a month,<\/p>\n

Dan:<\/strong> \u2026They take it down to about 2300.<\/strong><\/p>\n

Devo: Okay.\u00a0<\/strong><\/p>\n

Dan: But by paying $300 less, we pay more for things like office visits, which we use a fair amount of, um, to see therapists and stuff like that.<\/strong><\/p>\n

Dan hosting: <\/strong>I mean, look: ?You think I could make a show like this without some serious support for my mental health?<\/p>\n

One reason we\u2019re looking at these super-expensive plans is: our therapists accept them. The co-pays to see them for the \u201cless-expensive\u201d plans were much higher \u2014 it ate up all the savings. I had a whole little spreadsheet.<\/p>\n

And I was hoping Devorah would be like, \u201cWow, you\u2019re so good at math!\u201d But she was looking at those totals for the full year and doing her own math.<\/p>\n

We\u2019ve got a kid who\u2019ll be applying to college next year, and Devorah\u2019s been using a tool called the \u201cnet price calculator\u201d \u2014 looks at a bunch of factors, and gives an estimate of what we\u2019d probably pay after any financial aid.\u00a0<\/p>\n

Devorah was mentally comparing what she\u2019d seen there to what my spreadsheet said we\u2019d be paying for health care next year.<\/p>\n

Devo: Do you know that this looks exactly like what the net price calculator says we might pay for college in a year? No, I\u2019m serious.\u00a0<\/strong><\/p>\n

Dan: I know you\u2019re serious.\u00a0<\/strong><\/p>\n

Devo: I\u2019m like writing the net price calculator with our income and it\u2019s coming out with like almost the exact number you\u2019re saying we could pay on healthcare.<\/strong><\/p>\n

Dan: Yes, that\u2019s right. And this is\u2026\u00a0<\/strong><\/p>\n

Devo: that\u2019s insane.\u00a0<\/strong><\/p>\n

Dan: And this, right. Well, and this is, the big number to look at next is deductible. And that\u2019s where things get very different.\u00a0<\/strong><\/p>\n

Dan hosting:<\/strong> Especially because all of these plans \u2014 the \u201ccheaper\u201d ones and our current one\u2013had a feature I\u2019d never noticed before: *family* deductibles. A kind of safety valve where if one person\u2019s expenses passes a certain point, insurance kicks in for the whole family.\u00a0<\/p>\n

On the quote-unquote \u201ccheaper\u201d plans, those family deductibles were five thousand, even ten thousand dollars more.<\/p>\n

I mean, I hope we don\u2019t end up in that kind of territory. The deductibles on our current plan are already in the thousands of dollars. But if we ever got there, I\u2019d sure want to stop the bleeding five thousand dollars sooner.<\/p>\n

Devo: I kind of am leaning towards\u00a0<\/strong><\/p>\n

Dan: Yeah. Keeping what we have.\u00a0<\/strong><\/p>\n

Devo: Keeping what we have.<\/strong><\/p>\n

Dan: Right? Yeah. It\u2019s weird because I\u2019m like, wow, but that\u2019s\u00a0<\/strong><\/p>\n

Devo: $6,000 more a year. Okay. Okay. I\u2019m gonna go take some deep breaths now.\u00a0<\/strong><\/p>\n

Dan: Yeah,\u00a0<\/strong><\/p>\n

Devo: I don\u2019t like it.\u00a0<\/strong><\/p>\n

Dan: No, me either. Sorry. Thank you for joining me with this. I\u2019m sorry. Super sucks.<\/strong><\/p>\n

Dan hosting: <\/strong>It does \u2014 and six thousand dollars is a LOT of money for us. But it turns out, those \u201calternative\u201d plans don\u2019t save us any money, and they leave us potentially on the hook for thousands and thousands of dollars more.<\/p>\n

So I am taking this as a win. And it\u2019s the lesson: If there\u2019s ANY way to look beyond the monthly premium, you gotta do it.\u00a0<\/p>\n

Read the fine print! If you\u2019ve got ongoing health care stuff \u2014 or stuff you\u2019re GONNA do next year, like, I dunno, have a kid? \u2014 price it out for any plan you\u2019re considering.<\/p>\n

Learn the stupid vocabulary: Deductible. Out of pocket max. This time around, I actually learned a new one: FAMILY deductible.<\/p>\n

And then we get back to Emily\u2019s case. Which actually has a happier side to it. Especially after we read some fine print.<\/p>\n

Emily, we left you with Elisabeth Benjamin. She had a couple of options for you.<\/p>\n

Emily hosting:<\/strong>\u00a0 Yeah. I could either re-enroll in what I have now for 867 dollars a month. Or get a plan with a slightly cheaper premium with even crummier coverage. No matter what, I\u2019m looking at paying a way bigger percentage of my income on health insurance.<\/p>\n

Dan hosting:<\/strong> Yeah, because you\u2019d lose the subsidy you have now. But my guy Kurt, my insurance broker,\u00a0<\/p>\n

Emily hosting:<\/strong> Kurt!\u00a0<\/p>\n

Dan hosting:<\/strong> He says there\u2019s another way: If I can bring you on at 30 hours a week \u2014 versus now you\u2019re at 20 hours \u2014 then Blue Cross of Illinois would consider you a full-time employee, eligible for ben efits with An Arm and a Leg. And.. you, know, I\u2019m working on it\u2026<\/p>\n

Emily hosting: I know. I know you are.<\/strong><\/p>\n

Dan hosting:<\/strong>\u00a0 Yeah so, toward that end, Kurt has sent me a couple of plans that you could enroll in. And like even if you had to pay the whole premium, they\u2019re less than these New York plans. One\u2019s like six hundred, the other is about six-ninety.<\/p>\n

But the question is: Does that really save you money? It depends on what they\u00a0 cover. I dug up the spreadsheet Kurt had sent me.? And we looked at it together on Zoom last week.\u00a0<\/p>\n

\u2026 I\u2019ll put it in the chat.<\/strong><\/p>\n

Emily: Okay<\/strong><\/p>\n

Dan: so the first number is, let\u2019s just look<\/strong><\/p>\n

Emily: Wait I\u2019m putting I gotta put Zoom on, uh, 200% here.<\/strong><\/p>\n

Dan: Yeah, yeah. You for sure.\u00a0<\/strong><\/p>\n

Emily: \u2026cuz they\u2019re little. Okay, okay.\u00a0<\/strong><\/p>\n

Dan: So. This number really pops out at me, what is the overall deductible? It seems to say $850 deductible.\u00a0<\/strong><\/p>\n

Emily: Mm-hmm Mm-hmm .<\/strong><\/p>\n

Dan: Sounds pretty good. Sounds a little like, is that a typo?<\/strong><\/p>\n

Emily hosting:<\/strong> OK- lower premium, lower deductible. What about my copays? Remember \u2013 my New York marketplace options have zero dollar copays for insulin and diabetes supplies.\u00a0<\/p>\n

Dan: This would be one where we would like, have to do a little more digging to figure out what your out OFP pocket would be.Let me see what I can find out. Lemme see what I can\u2026\u00a0<\/strong><\/p>\n

Emily: Yeah I mean like the advice that we were giving people like\u2014 contact your HR department. It\u2019s like, Dan are you the HR department?\u00a0<\/strong><\/p>\n

Dan: I am, I am. So I\u2019m like, yeah, let\u2019s do this. Let me, this is gonna take a\u00a0<\/strong><\/p>\n

Emily: Yeah yeah.<\/strong><\/p>\n

Dan hosting:<\/strong> Honestly, it took forever. We spent another twenty minutes on that call, trying to get information from my Blue Cross website, and then from Google. Which ended up sending us to Facebook group discussions and Reddit threads.\u00a0<\/p>\n

Emily, you took some time on her own\u2013 OK a lot of time\u2013 you called your insurance, and your pharmacy, and I forget who else\u2013 and ultimately, with your incredible Google skills, you found the document we needed: The 2026 formulary for Illinois Blue Cross plans.<\/p>\n

Emily hosting: <\/strong>Yes, the formulary. That\u2019s an insurance company\u2019s list of ALL THE DRUGS they cover\u2013\u00a0 and what you\u2019d pay for each one. If you\u2019re a First Aid Kit newsletter subscriber, you know we just wrote about them last week. Ok, so we started off looking for my continuous glucose monitor supplies.<\/p>\n

At first, it looked like: They were gonna be kind of expensive. $60 a month. But there were little letters off to the side\u2013 one was CW, which seemed to stand for \u201ccost waived.\u201d We hit Control-F\u2026<\/p>\n

Dan: Okay. So that\u2019s here. It says, uh, cost waived \u2013 CW \u2013Medicines marked with a CW in the coverage requirements and limits column are mandated in the state of Illinois to have $0 member cost.<\/strong><\/p>\n

Emily: Hey.<\/strong><\/p>\n

Dan: Yeah, right. Yeah.<\/strong><\/p>\n

Emily hosting:<\/strong> Next\u2026 we looked up my insulins.And I do have a copay there \u2013 $85 a month, which is unfortunately pretty normal. And so this plan was still looking like a winner. Because of that lower deductible. And then \u2014 after we did one more round of due diligence \u2014 we figured out \u2014 it was even better than we initially thought.<\/p>\n

Dan hosting:<\/strong> Yeah, we downloaded another set of paperwork. Every plan has a document called the Summary of Benefits and Coverage, so we grabbed those. With the New York plans, those documents confirmed: you would have to pay out that whole deductible before seeing a doctor. Then we looked at that same document for this Illinois plan. And found THIS:<\/p>\n

Dan: If you visit a healthcare provider\u2019s office, primary care to treat an injury or illness, deductible does not apply.<\/strong><\/p>\n

Emily: Hell yeah.<\/strong><\/p>\n

Dan: Yeah. Whew. All right. That seems like a good deal.<\/strong><\/p>\n

Emily: Yeah. Yep. Exactly.<\/strong><\/p>\n

Dan: All right, cool. This is excellent. Okay. So I think what we\u2019ve found through our sleuthing, your sleuthing is, yeah, this is a better deal and it\u2019s all in the fine, it\u2019s all in the fine print.<\/strong><\/p>\n

Emily: It is, yeah.<\/strong><\/p>\n

Dan: Yeah. Alright. All right. Well this is good. I feel like we are like, now all you gotta do is raise money to bring you on for the extra hours and you know, but like we\u2019ve done the hard part.<\/strong><\/p>\n

Emily: Yeah, yeah, exactly. Exactly. We\u2019ve deciphered, um, insurance lingo\u2026<\/strong><\/p>\n

Dan: Oh my God.<\/strong><\/p>\n

Emily: \u2026and now we just have to pass a hat around, so.<\/strong><\/p>\n

Dan: Let\u2019s do it.\u00a0<\/strong><\/p>\n

Dan hosting:<\/strong> So, OK, we have modeled some stuff for you here:<\/p>\n

If there\u2019s medical stuff you know you\u2019re gonna need: Look beyond the monthly premium.<\/p>\n

Look at that Summary of Benefits and Coverage. Look for the drug formulary. Read the fine print. Use Control-F. Make calls.\u00a0<\/p>\n

And we have a ton of resources to help you keep the whole thing straight: We\u2019ve covered this stuff before, in depth, in our First Aid Kit newsletter, and on the podcast \u2014 and we\u2019ve collected the most-important, most-useful stuff, and organized it into a Starter Pack on our website.You\u2019ll find a link wherever you\u2019re listening to this.<\/p>\n

And look: there are people for whom NONE of this gets you to something workable. The spikes in health insurance premiums, and the lower subsidies, they mean a lot of people are just stuck.<\/p>\n

The folks at NPR talked with a woman last week who\u2019s in the middle of cancer treatment. Her health insurance is scheduled to jump from three hundred some dollars a month to like 12 hundred dollars. Which she absolutely cannot afford.<\/p>\n

There will be people looking to take advantage of this whole crunch: Pitching junk insurance plans and other \u201cbargains\u201d that don\u2019t actually cover enough.<\/p>\n

And there will be a lot of people facing bills they just cannot pay. Medical debt \u2014 and aggressive debt collections \u2014 all of that is gonna hit even more people.<\/p>\n

Which, honestly, is why it\u2019s so important for us to keep doing this work. Together. So many people are going to be in so much need in the coming year \u2014 years.<\/p>\n

Everything we can learn about fighting unfair bills, applying for financial assistance, avoiding ripoffs, and HELPING EACH OTHER. We\u2019ve gotta keep spreading it around.<\/p>\n

And to do all of that: We need your support. For example: yes I want Emily to have more hours so she can have insurance, but I need more of her time because we\u2019ve got so much work to do.\u00a0<\/p>\n

So yeah, we need your help.<\/p>\n

And this is the ABSOLUTE best time to help us. Through the end of the year, the NewsMatch campaign from the Institute for Nonprofit News is matching donations of up to a thousand dollars.<\/p>\n

And if you\u2019re catching this in November, well: Through the end of the month, because of a special matching fund from the Jonathan Logan Family Foundation, those donations are DOUBLE-matched.\u00a0<\/p>\n

You give us a hundred dollars, and in November, it gets turned into three hundred dollars.\u00a0<\/p>\n

And lots of you have been taking advantage of this opportunity in the last few weeks. It\u2019s amazing.<\/p>\n

And some of you have been adding notes. Kimberly from Texas wrote: \u201cThank you for all your hard work! I feel surrounded by support knowing you, your (tiny) team, and all your listeners are out there, caring so much.\u201d<\/p>\n

Kimberly, thank YOU so much.<\/p>\n

OK: The place to go is arm and a leg show dot com, slash support.<\/p>\n

Arm and a leg show dot com, slash, support.<\/p>\n

We\u2019ll have a link wherever you\u2019re listening. Everything you give gets matched. Let\u2019s do this now.<\/p>\n

Thank you SO much. Arm and a Leg show dot com, slash, support.<\/p>\n

We\u2019ll be back with another episode soon. Till then, take care of yourself.<\/p>\n

This episode of An Arm and a Leg was produced by Emily Pisacreta and me, Dan Weissmann, with help from Claire Davenport \u2014 and edited by Ellen Weiss.\u00a0<\/p>\n

Adam Raymonda is our audio wizard.<\/p>\n

Our music is by Dave Weiner and Blue Dot Sessions.\u00a0<\/p>\n

Claire Davenport is our engagement producer.<\/p>\n

Sarah Ballema is our Operations Manager. Bea Bosco is our consulting director of operations.\u00a0<\/p>\n

An Arm and a Leg is produced in partnership with KFF Health News. That\u2019s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling, and journalism.<\/p>\n

\u00a0Zach Dyer is senior audio producer at KFF Health News. He\u2019s editorial liaison to this show.<\/p>\n

An Arm and a Leg is distributed by KUOW, Seattle\u2019s NPR news station.<\/p>\n

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.<\/p>\n

They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.<\/p>\n

Finally, thank you to everybody who supports this show financially.<\/p>\n

You can join in any time at arm and a leg show, dot com, slash: support.<\/p>\n

And in fact:\u00a0 Here are the names of a few people who have pitched in for this year\u2019s NewsMatch campaign.\u00a0<\/p>\n

\u201cAn Arm and a Leg\u201d is a co-production of KFF Health News and Public Road Productions.<\/em><\/p>\n

For more from the team at \u201cAn Arm and a Leg,\u201d subscribe to its weekly newsletter,\u00a0First Aid Kit<\/a>. You can also follow the show on\u00a0Facebook<\/a>,\u00a0Instagram<\/a>,\u00a0LinkedIn<\/a>, and\u00a0Bluesky<\/a>. And if you\u2019ve got stories to tell about the health care system, the producers would love to\u00a0hear from you<\/a>.<\/em><\/p>\n

To hear all KFF Health News podcasts, click here<\/a>.<\/em><\/p>\n

And subscribe to \u201cAn Arm and a Leg\u201d on Spotify<\/a>, Apple Podcasts<\/a>, Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

USE OUR CONTENT<\/h3>\n

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