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Hey there —

We’re picking up on a series we started a few weeks ago, looking back — in a year when lots of things got bumpy — on things that states did in 2025 to make things suck at least a little less.

In red, blue, and purple states, governors signed bills aimed at protecting people from things like medical debt, insurance delays and denials, and corporate profiteering.

We’re highlighting a few examples — talking to the people who fought for these new laws about what they did, and what they learned.

Today’s stories bring us voices from states 3,000 miles apart — from the “Pine Tree” and “Beaver” states. (That’s Maine and Oregon, respectively, and yes, I googled that.)

We hope these stories give you energy and hope for the new year. (Or at least an interesting companion while you’re running holiday errands.)

And if you’re up for some dense-but-enlightening holiday reading, read on for links to detailed legal strategies behind these new laws.

BUT FIRST

If you value our work, now is the best time to pitch in and help us keep doing what we love.

Donate

We’ve been truly blown away by the support lots of you have already shown — including the notes you’ve sent.

Hayley in Wisconsin wrote:

Most of the podcasts I listen to make me feel like I need to up my dose of Lexapro, but this one makes me feel like I might be able to fight back occasionally! Thank you for everything you do.

Yes! We can’t do this without you. If you haven’t made a donation yet, here’s your chance:

Donate

The fight to remove medical debt from credit reports

A year ago, the Consumer Financial Protection Bureau was close to finalizing a federal rule to remove medical debts from credit reports nationwide.

Their argument: Medical debts don’t predict whether you’ll pay other bills. And, vitally: The threat of a ding to their credit rating could push folks to pay debts they really didn’t owe.

But shortly after the rule came out in January 2025, the Trump administration took office, basically shuttered the CFPB, and did very little to defend the rule against a collections-industry lawsuit aimed at killing it.

In the meantime, a half-dozen states added their own laws to wipe medical debts from credit reports. (A total of 15 states now have laws like these.)

Most of those states were solidly Democratic, but today’s episode looks at Maine, which is a little closer to “purple” on political maps. (Or as one Reddit user described it, “blurple.”)

In Maine alone, a survey revealed that half of the state’s 1.4 million residents had medical debt. That debt will stick around, but — thanks to the new law — will at least no longer prevent them from being able to rent an apartment or buy a car.

But some of these new laws — in Maine and elsewhere — are drawing legal challenges now, too.

And — in a complete reversal from the Biden administration’s position — Trump’s stripped-down CFPB issued new legal guidance in October, offering arguments to support those challenges.

But: Those arguments are weak, argues Chi Chi Wu — senior attorney for the National Consumer Law Center, who has been working on this issue for years.

She’s got a guide to crafting state laws (and tweaking existing ones) with an eye to beating potential legal challenges.

Oregon: No, corporations shouldn’t run medical practice

This story started with a paradox: Like a lot of states, Oregon already had a law forbidding the “corporate practice of medicine.”

And yet, as State Rep. Ben Bowman noticed, big companies kept buying up medical practices in the state. Which often means jacked-up prices and worse care.

Which raised two questions: How did that happen? And how could it be stopped?

He got answers in a New England Journal of Medicine article by a trio of researchers — two legal scholars and a physician and public-health researcher.

Then, he called those researchers and invited them to collaborate with him on writing a new law for Oregon.

It took two years to pass. Today’s episode walks you through the curious legal issues, the political maneuvering, and the public scandals that got Bowman’s proposal over the finish line this year.

Nerdy bonus: we hear how a lawsuit we covered in 2022 — ER doctors suing to kick private equity out of California hospitals — partly set the stage.

If you want an even deeper play-by-play of what happened in Oregon, the folks at Organized Money — a podcast about monopoly power that (of course) shares a lot of our interests — have you covered.

Help us keep a great thing going

I can’t say this enough: We love doing this work.

And we love doing it for you.

We’re independent. We don’t have advertisers. No corporate overlords. Not even a whole bunch of money from big foundations.

Which does mean: We can’t do it without your support.

So please take a second right now and add your contribution — every dollar makes a difference.

Donate

Thank you so much!

Till next time,

— Dan

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Hey there,

Last year, we talked with tech worker Holden Karau, who had built an AI-powered tool to fight denials by insurance companies with the slogan “Make your insurance company cry, too!”

Since then, more tools have cropped up. A few months ago, an episode of The Nocturnists (a podcast made by and for health care workers) looked at a company called Claimable.

So did an NBC News story by the great reporter Gretchen Morgenson, whose clip also mentioned Holden’s tool and a couple of others.

Listeners sent us links to all those stories. Another listener wrote to us about an AI tool he was developing — trained in part, he said, with tips from our reporting — and invited us to test it. (We haven’t yet.)

Then, a few weeks back, some of you sent us links to a social media thread by a user who claims to have used Microsoft’s Claude AI assistant to help knock more than $150,000 off a hospital bill.

I haven’t done my own reporting on any of this, but it’s got me curious, so I want to share what I’ve seen so far — what could be promising, and what’s concerning. And to hear what you think.

But first…

We need your help

Because these newsletters, like our podcast, are all created by hard-working humans, not AI bots.

We love doing this. It’s the best job we could possibly have. We want to do more of it in 2026.

So we’re spending the rest of 2025 raising the money to make that possible.

Now’s the time: please donate to keep us working for you.

Donate here

Thank you so much!

OK, on to the bots…

Are insurance companies way ahead of us on AI? Maybe not (yet)

After all, as we’ve covered, they’re already using AI to deny claims by the gazillion.

But Claimable’s founder — who spent a couple of years working for the insurance company Anthem — says appeals are different.

“They have to be read by an appropriately qualified human,” he said in the Nocturnists episode.

Could insurance companies juice that process with AI? “Sure, over time,” he says. But: “These companies are often so antiquated on the inside that that’s actually quite a big lift.”

Of course, he’s literally got a stake in selling that answer: Otherwise, how could his company attract customers or investors?

But other recent reporting from the health and science outlet STAT News backs him up. A (paywalled) STAT story describes an AI arms race between hospital billing departments and insurance companies.

And STAT quotes an insurance company CFO admitting that insurers are behind.

For now.

“We’re going to catch up,” he says.

Can I just use an AI assistant myself?

Maybe, in some cases? But as an assistant, not a guru.

That’s my impression after reading the social-media thread by the user who says Claude helped save him $150,000 on a hospital bill.

For one thing, he wasn’t appealing an insurance company decision.

That’s a technical, structured process — and companies offering AI-boosted services say they’ve trained their AI models by feeding them specific, technical data.

This user was fighting the hospital itself over a bill that seemed wildly inflated.

And he did the kind of homework we’ve written about — starting by demanding an itemized bill, with billing codes (which he says the hospital took months to cough up).

And then — with help from Claude — looking up what Medicare would pay.

He says that, with Claude’s help analyzing Medicare rules, he found more than $100,000 in charges that violated those rules.

His next assignment for Claude: Drafting a stern letter to the hospital, “threatening legal action, bad PR, and appearances before legislative committees.”

Here’s his conclusion, about using a tool like Claude, and about fighting with hospitals:

Those last cautions — double-check any facts, treat any AI text as a first draft to edit, not a final copy — sound especially important.

And look: I haven’t done the reporting to verify the claims in this thread.

More than that: I’m as skeptical of AI hype as the next person (unless that person is my colleague Emily, who has me beat there). I especially hate seeing AI slop in my Google results. Recent stories about a possible burst to the AI bubble strike me as long overdue.

But I am cautiously curious about whether there might be something useful here.

If you’ve done some experimenting of your own with any of these tools, you can hit “reply” to this email or hit us up here.

Meanwhile, speaking of caution…

Please don’t just feed AI bots your medical records

Which people seem to be doing, according to a New York Times story out this week. Here’s a gift link so you can read the whole thing.

But here’s the key paragraph, if you’re short on time:

“Inaccurate information is a major concern; some studies have found that people without medical training obtain correct diagnoses from chatbots less than half the time. And uploading sensitive data adds privacy risks in exchange for responses that can seem more personalized.”

That link to the “major concern” about inaccurate info leads to another NYT story (and here’s another gift link): A.I. Is Getting More Powerful, but Its Hallucinations Are Getting Worse.

And the privacy stuff is no joke, since, as The Times notes: health-privacy laws like HIPPA only apply to health-care providers, not tech companies like OpenAI.

Of course, there’s a reason people turn to bots: Actual help from trained, human, health care workers is too tough to access.

As a heading in an earlier NYT story put it: “My doctor is busy, but my chatbot never is.” Ugh.

That’s it for this week! Thanks for reading, and thanks for donating to help us keep doing this work.

… and thanks for the incredible notes some of you have included with those donations. Here’s my favorite from the last week:

You all are doing some of the most important work in these times. I have no doubt that you are saving lives. I’m proud to support monthly and the occasional one-off because I know that your incredible work is making the world a better place. PS — I’ve already had one person tease me about how much I talk about and share your show, because I talk about you All. The. Time.

— Erica, Maryland

Thank you SO much, Erica!!!

And if you’ve donated — or are about to right now — thank you!! Here’s that donation button one more time.

Donate

Catch you soon,

— Dan

If you’re subscribed but First Aid Kit has stopped hitting your inbox, try whitelisting us, and make sure you’re subscribed. And you can contact us here.

Hey there,

Dan started An Arm and a Leg with the idea that we’re better equipped to face America’s broken health care system together. And this newsletter builds on that idea, sharing the most-useful nuggets, winning strategies, and useful resources we cover on the show.

And we couldn’t have asked for better company on that journey. Since we brought this newsletter weekly, you’ve asked us questions, shared your stories, and even made resources for fighting medical bills with the help of fellow readers.

THANK YOU!

Today, we’re sharing a tiny sample of tips, requests, and resources from our inbox — stuff we’d be remiss not to pass around.

But first — speaking of passing stuff around — we’ve got a hat to pass around. It’s our BIG fundraising season, and we need your help.

Now, until the end of November, any gift you give gets double matched. $25 turns into $75. So even if you can only share a little bit, that little bit gets multiplied and becomes a lot.

Help us build this community and keep sharing resources with each other next year.

Donate

Thanks! We can’t do this without you.

Another tip about prescriptions: check the instructions

David from Arizona wrote to expand on our recent tip for fighting sticker shock at the pharmacy counter:

“As a prescribing Nurse Practitioner, I’ve fielded many calls from upset patients frustrated over their prescription costs. A couple other things patients can do.

Verify “DAW” [Dispense As Written] wasn’t accidentally selected on the script. “Dispense as written” sometimes gets inadvertently selected in the electronic health record (EHR) when the provider is prescribing the drug.

[… which David notes can prevent your pharmacist from giving you a money-saving generic without bringing your provider back into the loop.].

Also the EHR dropdown menus occasionally have a myriad number of formulations for the same med. Double check!”

Thanks, David!

How about a tip sheet for health care workers??

“I’m a nurse at a safety net hospital and constantly see firsthand how the US healthcare system chews up and spits out all but the very wealthiest Americans … I’d love to see a resource specifically for how healthcare workers can best advocate for patients. A quick one-page tip sheet would be great!” – Lex from Minnesota

Lex,

It’s always incredible to hear from health care workers like you, who work so hard keeping people healthy and alive, but who refuse to walk away when they think they can do more. Thank you for what you do, and for asking this question.

You’ve probably seen the resource med student Thomas is building — a one-sheet guide for patients that health care workers (and really anyone else) can share, with links to a range of helpful orgs for getting care and avoiding debt.

(Anyone can still make suggestions for the next version or volunteer to pitch in.)

But we don’t yet have a comprehensive/compact list of tips for health care workers.

Maybe someone else has built that list? Or someone reading this wants to make that resource next?

Cartoons and data visualizations!

Listener Sarah Reed — an engineer, designer, artist, and self-described data geek — writes:

I’m a big fan of your podcast. What I love is that it brings a really human touch to a complicated and frustrating aspect of all of our lives. I’ve learned a lot listening to it.

I’m an information visualization developer and I’ve recently created a cartoon series focused on explaining the nerdy inner workings of our healthcare system. Like your podcast, I strive to explain this complicated behemoth we’re living in to regular people.

And they’re great!

• Our crazy system collects Sarah’s answers to some big-picture questions

• … and her portfolio includes work about the cost of cancer, the price of GLP-1 drugs, and her adventures shopping for a procedure.

As you can see — wow. We’re so lucky to have you as our readers and community in the fight against our messed-up health care system. So from the whole team at An Arm and a Leg: THANK YOU.

And please keep sending us your messages! You can do that here or by replying to this email.

There’s one more inspiring thing you’ve been sending us recently — donations! And sometimes, nice notes that go along with them.

This one, from Steph in Massachusetts, got us a little teary:

Your podcast is part of the reason why I’m a career changer applying for Patient Financial Counselor jobs. You’re all so incredible, thank you so so much for the work you do.

So, if like us, you find this community meaningful, consider donating right now — ‘cuz for four more days, every dollar you donate to our show gets tripled thanks to a program called NewsMatch.

Pretty cool, right? We’d love for you to join in. If you want to pitch in, you can do that here:

Donate

That’s all from me this week. Happy Turkey Day tomorrow to all who celebrate.

— Claire

If you’re subscribed but First Aid Kit has stopped hitting your inbox, try whitelisting us, and make sure you’re subscribed. And you can contact us here.

Hey there,

In a way, every year is the worst year yet to buy insurance, because rates go up every year. So each year is always cruddier than any year before.

But this year is especially awful. The rate hikes on employer-based plans are the highest in 15 years, and on the Obamacare side it’s even worse. Price hikes there are even steeper, and — barring an extremely-unlikely last-minute fix from Congress — subsidies will be less generous.

We can’t save you from any of that. But we can help you avoid the worst options — including outright scams.

That’s because we’ve been reporting on all this stuff for years. You’ll get a taste of what we’ve learned in today’s new podcast episode, and we’ll give you a guide here.

But first:

Yes, it’s still the BEST time to support our work

Because

(a) We’ve got so much work cut out for us in 2026

and

(b) Everything you give us in November is matched two-for-one.

So please help us take advantage of this incredible opportunity. Go ahead, hit “donate” now — we’ll be right here when you get back.

Donate

Thank you so much! You are setting us up for huge success. OK, on to the less-fun stuff.

Let’s start with the “avoiding scams” thing

Basically the same bad news as always: If a deal sounds too good to be true, it probably is.

And because so many people are, understandably, looking for a better deal than what you can find on healthcare.gov and state marketplaces… there are a lot of sharks out there ready to offer “alternatives.”

You type “buy health insurance” into Google, or follow links from social media, and those sharks will come knocking (and calling, and emailing…).

I should say: The most common too-good-to-be-true offerings are legitimate, legal-to-sell products, not outright theft.

But they’re often pitched by folks looking for a quick commission — eager to pitch their “benefits” (lower prices) and gloss over or skip their significant drawbacks (like, um, not actually paying for health care when you need it).

Those products include:

• “Short-term” plans, which the Trump administration is encouraging. They can exclude care related to pre-existing conditions … and a lot else. This Washington Post story (gift link) opens with the tales of three folks who wound up on the hook for amounts ranging from $82,000 to $116,000 — and quotes an insurance broker saying, “I couldn’t sleep at night if I sold that to somebody.”

• “Health care sharing ministries,” which don’t actually promise to cover the cost of your medical care — and aren’t overseen by insurance regulators. For a full rundown on the problems here, John Oliver’s 2021 episode on them is your most comprehensive and most entertaining bet.

• More exotic products, like the ones we learned about from two Bloomberg reporters in this recent podcast episode.

Basically: Obamacare really is way too expensive, and has a lot of problems. But the alternatives are worse. Anybody pitching one as a panacea… Well, I wouldn’t trust them.

Finding your least-worst option

This is no fun. And it’s hard. As we discussed in one of our first-ever podcast episodes, it’s something very smart people dread.

But as we confirmed in doing our own insurance shopping — and as you’ll hear in today’s podcast episode — doing it really can save you thousands of dollars.

We’ve covered the details in earlier newsletters and brought them all together in this starter pack on our website.

Here’s a quick digest of the advice you’ll find there:

• Look past the monthly premium: If you actually need health care, the plan that looks the “cheapest” could cost you a ton of extra money.

• Find the documents you need: The summary of benefits and coverage, and the drug formulary are the two biggies.

• Learn the awful vocabulary: Deductible, coinsurance, out-of-pocket max, out-of-network, pricing tiers.

… and then, for any plan you’re considering, start doing that math: What’ll you really end up paying out of pocket for medical care? We’ve outlined the process here. It sucks.

Oh, also this: Get help, anywhere you can. At work, hit up HR: Does somebody there have office hours?

If you’re looking at Obamacare plans, see if you can find a navigator: These are trained folks who can help you find the best plan. They don’t work on commission, so their only incentive is to get you the best coverage. You hear Emily getting help from one in today’s episode.

The bad news: As we’ve discussed, the federal government slashed funding for navigators this year. But a lot of states fund their own program. See what you can find.

And if navigators aren’t available: Ask friends and family to recommend a good insurance broker. My family works with a great one.

Finally, one more time: We’ve compiled our best advice into this starter pack on our website.

I wish we could make this easier, or less frustrating. Or make the alternatives less crappy.

But as we learned by applying these lessons ourselves: The difference between the worst and the least-worst option could be huge.

And…

Who’s the best? You.

You’ve been supporting our work — we see you!

And if you’ve been meaning to, here’s that donation button one more time:

Donate

Thank you so much!!

Catch you next week,

— Dan

If you’re subscribed but First Aid Kit has stopped hitting your inbox, try whitelisting us, and make sure you’re subscribed. And you can contact us here.

Hey there,

Back when we reported our Prescription Drug Playbook series about how to avoid sticker shock at the pharmacy counter, one piece of advice came up again and again:

If you rely on specific meds, you need to do some homework when it’s time to pick next year’s insurance plan.

And that time has come, friends — whether you’re picking from different options through work, looking at Medicare Part D plans (that’s the drug-coverage letter in Medicare’s alphabet soup), or shopping for an insurance plan through the Obamacare marketplace.

Picking a better drug plan now can save you thousands of dollars in 2026 — and big headaches. And your primary care provider can be a HUGE help in choosing the right one.

“Thank 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.”

That’s a note we got this week from a donor named Kimberly from Texas that made us melt.

And this month, donations like Kimberly’s get tripled (!!!) thanks to a program called NewsMatch by the Institute for Nonprofit News.

Now through November, every dollar you donate gets matched two to one. Like… if you donate $25, we get $75.

This is our big fundraising season. So if you care about the work we do, and want to help us keep doing it, smash this donate button:

Donate

OK, now for that “saving you thousands of dollars” thing…

Don’t re-enroll without checking your plan

Your plan might work for you right now, but here’s the thing: The list of drugs that plan covers could change when the new year starts.

Jeanne Chamberlin, a volunteer coordinator for her state’s Medicare helpline, says these changes creep up on a lot of the seniors she talks with.

“People come in January… and say, I just went to the pharmacy and they want $300 for my medicine. And last year, or last month, it was $30,” Jeanne says.

Yikes. We want to make sure you avoid that scenario.

So take advantage of this moment. And give yourself some time. Crack open a soda or fix yourself a cup of tea (though maybe not Sleepytime). This could take a while.

Step 1: Hunting down the “formulary”

The formulary: That’s the master list of drugs your plan covers, and at what cost.

You want to review your current plan’s formulary for 2026 — and check it against other plans to see if you’d benefit from switching.

And because nothing in health care is allowed to be easy, those formularies live in different places, depending on where you get your insurance.

If that’s from work, “formulary” may not be in the first link HR sends you about enrollment — you might have to dig a little. (A doc called “Summary of Benefits and Coverage” might be a good place to look.)

If you’re coming up empty, or confused, call your HR Benefits manager.

If you’re shopping for an Obamacare plan, healthcare.gov, and at least some state marketplaces, allow you to enter the drugs you take in a search field to get answers about which plans cover them.

For Medicare, Plan Finder makes it even easier. (If it’s not glitching out.) When you shop for Part D plans, you start by entering a list of your drugs. The site will generate a list of plans available in your area that cover them, and at what cost. You can sort the results by “lowest drug + premium cost.”

But even with these shortcuts, you’ll still want to see the formulary to get all the details.

Step 2: Understanding the formulary

Congratulations, you found the right document. Now you just have to…decode it. Ugh.

Formularies are long, ugly documents. And even with the hydration of a good can of soda or warm cup of tea, you could still get a nasty headache reading through it. But some basics:

1. Hit Ctrl +F to search inside the document for your drugs.

2. You’ll probably see “tiers.” Tier 1 drugs are the cheapest for you. Higher tiers get more expensive from there — sometimes WAY more expensive -– all the way up to, potentially, sticker price.

3. Some drugs may be subject to other roadblocks, like a “prior authorization,” where your provider has to make a case that you need this particular med. You’ll usually see these listed in a section called “restrictions” or “notes.” All super-fun.

4. Honestly, there’s more technical garbage than we can explain here. Luckily, this guide from the Patient Advocate Foundation does a terrific job.

Again, this could take a while. Stay strong.

And it might yield bad news: Like, no plan covers all your meds at decent-sounding prices, or without onerous hoops to jump through.

In which case…

Step 3: Tapping in your provider

First, they may have alternatives for you. So ask:

• Is there an equivalent version of this medicine that would be cheaper? Like…a tablet instead of a capsule?

• What about a comparable version, like from another brand or even a generic?

• What would work for me, in combination with the other meds I’m on?

Second, if there are hoops to jump through — like those prior authorizations we mentioned — they’ll be doing a bunch of the work. Bringing them in now can give you a running start.

Also, they may know which plans make those hoops harder to jump through, or issue more denials — meaning, which plans you probably want to avoid.

More resources for open enrollment

For folks on Obamacare plans, trained navigators offer unbiased info about plans in your area.

And for folks on Medicare, resources like SHIP or the Medicare Rights Center are a must.

Finally, if you want to do a deeper dive on other options for getting your meds at an affordable price, check out our Prescription Drug Playbook. And let us know how it all goes!

And hey — one more time: If you find our reporting indispensable, please consider donating — seriously, every dollar counts. And every dollar is worth three dollars right now. Here’s that button again.

Donate

That’s all from me for now. Good luck shopping.

— Claire

Big news! First Aid Kit moved from Substack to our very own website. Which means…

If you’re new and looking to subscribe, do that here instead of Substack.

If you subscribe through Substack, we’ll still add you to our list, but this will ensure you don’t miss the latest. And make sure to check your inbox for that welcome email.

If you’re a longtime reader, but First Aid Kit stopped hitting your inbox, double-check you’re subscribed.

If you are, and we’re still not showing up in your inbox, try “whitelisting” us, aka telling your inbox that we’re not spam.

And if you’re a new reader, make sure to whitelist us (here are some instructions) to make sure we don’t get sent to your spam folder.

If you have any issues subscribing, please message us here.

Happy reading!

The Arm and a Leg team

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Hey there —

So much to share this week, including a new podcast episode out today, but let’s start with a story that reminded me of this year’s Prescription Drug Playbook. This one’s from a listener — my friend Tim.

Tim’s doc prescribed a basic antibiotic — and the pharmacist said the charge would be $100.

Tim was like, WTF? A basic antibiotic, not covered?

He called his insurance and got the answer: His plan didn’t cover the antibiotic in the tablet form Tim’s doctor had prescribed. But the capsule form? Four bucks.

ARGH. Let’s all remember that one. I’ve gone and added this to our checklist for fighting pharmacy-counter sticker shock.

(BTW, I talked about our prescription-drug tips for an episode of NPR’s Life Kit podcast that came out this week!)

Speaking of new episodes…

Hey wait! First: Big opportunity this month

This newsletter and our podcast rely on your support — and this is the absolute best time to support us.

That’s because in November, any donation you make to us will be matched two-to-one.

Yep. If you give us, say, $50, we get $100 in matching funds. Your donation is tripled.

Donate Now!

This is all thanks to NewsMatch, an initiative from our pals at the Institute for Nonprofit News, with extra matching funds from the Jonathan Logan Family Foundation.

We have SO much work to do in the coming year. And right now your help counts for triple.

I'll Match My Gift!

Thanks! OK, now…

New episode this week: What didn’t suck in 2025

Yep, you read that right.

True, 2025 has been rough. See, for instance, the federal government being shut down because Congress won’t extend health-insurance subsidies that 20 million people rely on.

And that’s just on health care, and just for starters.

But state governments — in blue states, purple states, and red states — have done stuff on health care this year that did not suck at all.

Stuff like: Creating new protections from predatory debt collectors, and new limits on the hoops insurance companies can make you jump through — aka the ever-increasing burden of prior authorization — that can cause delays and denials for vital care.

So many states have acted on so many issues, it’s gonna take us multiple episodes just to give you a good sample. Starting with this one.

Today’s episode takes us to Nebraska, where the state passed aggressive new restrictions on prior authorization. (19 other states also passed new prior-auth rules this year.)

And Virginia, where lawmakers banned wage garnishment for lots of medical debts.

We’ve also been talking to folks in Maine — one of a half-dozen states that restricted the listing of medical debts on credit reports.

And Arkansas, one of a *bunch* of states to pass new rules on pharmacy benefit managers — the middleman companies that decide how much you pay for drugs.

And Oregon, which passed a law restricting the ability of big corporations to buy up medical practices — a law inspired in part by events we reported on last year that involved the ever-more-enormous (and hated) UnitedHealth Group.

So, you know: Stay tuned.

Also: Open enrollment is here

And it’s a real mess.

In addition to the double-whammy on ACA plans — higher premiums plus (still) greatly-reduced subsidies — premiums are skyrocketing for everyone.

Workplace plans are projected to see their biggest increases in 15 years.

This hits close to home: My family’s plan is gonna cost about $6,000 more in 2026. My colleague Emily’s still figuring out how she can afford her own insurance for next year, and I’m trying to raise enough money so An Arm and a Leg can be part of the solution.

…and of course it’s not just us. We’ll have more in the next couple of newsletters, and in our next podcast episode.

Meanwhile, here’s a gift link to a New York Times story with shorthand answers to some big questions (including: “Can A.I. help me choose health coverage?” Short answer: Um, not without a lot of human-powered checking.)

…and an Arm and a Leg starter pack with our best advice on how to shop for health insurance.

More soon. For now…

Thank you so much!

… for helping us keep doing this work. Your stories, your questions, and yes — your donations (matched two-to-one this month!) — power everything we do.

Here’s a note that made my week. It arrived just as our fundraising campaign started, from a health care provider named Tamara:

Your reporting has helped me help my patients, as well as my own family, to find quality, affordable healthcare. I started accepting insurance in my private practice about a year ago, and was better prepared for the obstacles thanks to what I’ve learned so much through An Arm and a Leg that I wish I had been taught in grad school.

Also, we’re an ACA insured family, since my husband and I are both entrepreneurs. This next year’s going to be a wild one, so I really need y’all to be around to keep giving us the real real!!

Tamara made a $50 donation, and the two-to-one match means her gift meant $150 to fund our work.

Let’s keep it going! Here’s that donation link again.

Donate here

Thanks again. Catch you soon. Till then, take care of yourself.

— Dan

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Hey there —

Ermahgerd, Medicare is confusing. Or as John Oliver said in a recent Last Week Tonight segment on Medicare Advantage, “On a scale of one to Inception, it is basically Tenet. And I don’t say that lightly.”

So yeah, like we said in our last Medicare installment, there’s so much important stuff to know before enrolling — and it’s wayyyy more than we can cover in one newsletter.

But luckily, there are resources that can help you wade through the alphabet soup of Medicare’s parts and plans, and we’re going to get into those today.

… and tell you about a deadline you really don’t want to miss.

But first, let’s say it again: Beware the Medicare Advantage hype.

We highlighted some of the drawbacks that come with Medicare Advantage two weeks ago, and John Oliver’s segment about the program really drives the point home.

Honestly, you should just watch it.

Oliver’s take: Medicare Advantage is so much worse than traditional Medicare, that it’s misleading to even use “Medicare” in the name.

As examples, he shows reports citing that in the majority of Medicare Advantage plans, 30 to 60 percent of the locations in their provider directories are inaccurate, and that virtually 99% of Medicare Advantage enrollees are required to obtain prior authorizations for some services.

And he takes particular aim at the industry’s relentless and often misleading marketing tactics — like celebrity-studded commercials that flood cable TV.

“Whatever you do, do not call those broker numbers on TV, because they won’t give you unbiased advice. They get much higher commissions if they funnel you to Advantage plans,” he says. Point taken.

Luckily, there are trustworthy resources out there.

As we mentioned in our last installment, every state has an agency called SHIP (for State Health Insurance Assistance Programs) you can call to help you navigate all this.

And there’s the Medicare Rights Center — they help over 20,000 folks a year with this stuff.

And the big takeaway from our reporting last year: You should definitely call one of these places when it’s getting close to your 65th birthday. Because you have a limited window to enroll in Medicare: three-and-a-half months on either side of your 65th birthday.

Even if you’re leaning toward a Medicare Advantage plan (despite John Oliver’s warnings), you still gotta do this.

So figure out when that is, and save the dates in your calendar.

Seriously, don’t blow that deadline.

If you miss it, you can still sign up eventually… but you have to pay a penalty every year for the rest of your life.

And millions of folks end up paying Medicare late-enrollment penalties each month because they missed enrollment deadlines, according to an AARP report.

There are some exceptions to this rule where you can avoid that penalty — like if you’re still working after 65 and have insurance through your job.

But figuring out whether you qualify for an exemption — and finding the right paperwork to submit if you do — can be super confusing. And finding a straight answer online is nearly impossible. (At least it was for me. And my editor. And Dan.)

So again: Get help from a human. Reach out to the folks at SHIP or the Medicare Rights Center to walk you through it. Seriously, save those links.

And if you haven’t been convinced yet, you’re about to be. Because it’s time to dive into the alphabet soup of Medicare’s parts.

A, B, C, Easy as…

Hahahaha we wish. Of course, it’s complicated.

You might have heard the terms Medicare Parts A, B, and C. Part C, confusingly, is Medicare Advantage, so let’s put that aside for now.

Part A covers inpatient care — hospitals, skilled nursing facilities, and hospice.

Part B pays 80% of your doctor’s visits and related care, like tests, as well as medical supplies and preventive services. Everyone pays a monthly premium for Part B, usually deducted from your social security check. (In 2026, that’s estimated to be $206.50.)

And yep, by everyone, we also mean folks on Medicare Advantage plans, too.

Some Advantage plans promise “$0 premiums.” But Emily Whicheloe, director of education at the Medicare Rights Center, calls those claims “misleading,” and says it’s one of the top things they get questions about.

“A $0 premium does not mean you are off the hook for the Part B premium,” she says. “Everyone is responsible for that, even if you take a Medicare Advantage plan.”

So yeah, cue John Oliver slamming on his desk.

There are more letters!

Head already spinning?

First there’s Part D, drug coverage — all of which is administered by for-profit companies. It’s a whole thing we’ll get into in future installments.

Then there are the supplementals — AKA Medigap plans — to fill in that “gap” of 20% not covered by Part B in traditional Medicare, as well as other copays, deductibles, and co-insurance.

And for the supplementals…the whole alphabet starts over again! Medigap includes plans labeled A, B, C, D, F, G, K, L, M and N.

Here’s a chart that summarizes what each Medigap option generally covers. But once again, it’s probably better to bring in the experts to help you navigate this alphabet soup.

So one more time:

SHIP: https://www.shiphelp.org/

Medicare Rights Center national helpline: 800-333-1144

The feds also run a 1-800-Medicare phone line you can call with questions (though that may be less helpful until the end of our government shutdown.)

And if you want a deep dive: Check out journalist Phil Moeller’s book Get What’s Yours for Medicare. He has done his homework. Or follow his Substack “Aging in America.”

And another great resource is the book Medicare for You by Diane Omdahl. We spoke with both Diane and Phil while putting together this newsletter series.

And a final word of caution: As Oliver’s segment highlights, as you approach 65, you’ll probably get calls from insurance brokers, or be invited to “understanding Medicare” workshops. Brokers can be helpful, but as this study underlines, many brokers have a financial incentive to steer you to Medicare Advantage. So stay on guard.

Whew, that was scary. At least... It’s a great transition to a spooky weekend?

Have a Happy Halloween — and let us know if you have any health-care-inspired costumes you’re rocking this fright night. Like, anyone out there dressing up as an insurance denial.

— Claire

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Hey there —

We’ve got a new episode out today, and a new way you can pitch in with a big project.

When health economist Vivian Ho asked us to help her gather data for a new study, I wanted to hear her out.

A disclosure: Vivian’s been a donor to this show — not a make-or-break donor, but a generous and encouraging one, which is how I met her, learned about her work… and became kind of a fan.

Having studied the US health care system for decades she’s spent recent years trying to actively make a difference.

She’s done that by publishing findings on core Arm and a Leg questions like “When hospitals get richer and more profitable, do they give more charity care?” (Reader, they do not.)

And: “Why does employer-sponsored health insurance keep getting more expensive?” She’s come to believe the biggest reason is, hospitals charge too dang much. (Not the only reason, but the biggest.)

And she’s got ideas about what to maybe do about it — to save workers a lot of money.

To stress-test those ideas and build on them, she needs more data, including a bunch of actual hospital bills from 2025 — as many as she can get her hands on.

Which is why she asked for our help: She’s hoping listeners (and readers like you) will be game to support her research, by sending her a recent hospital bill.

As you’ll hear in the episode: I think her project is a good idea. I’ve sent her a hospital bill of my own — a test I went in for earlier this year — and I hope you’ll consider doing the same.

How to share your documents with Vivian and her team

Vivian and her team at Rice are collecting bills and EOBs (explanations of benefits: the statements your insurance plan generates when they get a bill.)

There are a couple steps to follow — including redacting your personally identifying information. But it took me like five minutes, I promise.

You can find all details about how to send them here.

Coming up on An Arm and a Leg: a new series we’re calling (for now) “Things that did not suck in 2025.”

Like I say in every episode, I like a challenge.

‘Til then, take care of yourself.

— Dan

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Hey there —

Our first podcast episode about Medicare — covering things to know before signing up — had a subtitle: “This one kind of blew our minds.”

There is so much to know — so many potential pitfalls and complications. And it left me thinking: “I’ll need to do some serious planning, years before I turn 65.”

So: please pass this newsletter to anyone you know who’s within a decade of that age.

Actually, pass along this newsletter and upcoming ones: It’s gonna take a few installments, just to cover the basics.

Signing up for Medicare can involve some unpleasant surprises. For one, it’s not actually 100-percent-free health care for the rest of your life. Pretty much everybody pays a monthly premium — $185 this year, for traditional Medicare.

And there are a ton of complicated — and sometimes costly — decisions and deadlines.

This time, we’re looking at the biggest, most-consequential choice: Which kind of Medicare to sign up for.

There are two basic flavors of Medicare — traditional Medicare, run by the federal government, and Medicare Advantage, which is funded by the government but run by private insurance companies.

You have to pick one when you first sign up. And for reasons we’ll get into, we want to flash a big yellow caution light about choosing Medicare Advantage.

The pitch for Medicare Advantage

Medicare Advantage gets a ton of marketing. In one survey, three quarters of seniors said they saw at least one ad per day. A third said they got flooded with telemarketing calls — seven or more every week. And in some cases, “workshops” offered by insurance brokers amount to a Medicare Advantage sales pitch.

And Medicare Advantage can look really attractive.

That because traditional Medicare comes with price tags and limitations most of us don’t expect. There’s a deductible. And exclusions — like dental, hearing, and vision coverage.

But most importantly: For most medical services — pretty much everything but inpatient hospital stays and meds — traditional Medicare only covers 80 percent.

To cover that last 20 percent, you need to pay for a supplemental policy — often called “Medigap.”

And you want that covered. Think about 20 percent of a bill for cancer treatment. Outpatient surgery? Chemo? Radiation? Scans and tests?

Sarah Jane Tribble, a reporter from KFF Health News who taught us a ton about Medicare, summed it up for me.

“You could pay out the wazoo,” she said. “It could bankrupt you.”

Medicare Advantage plans pitch themselves as an antidote: No need to buy Medigap. Everything’s covered in one policy, often with a low premium. And they can promise to cover things traditional Medicare doesn’t — dental care, vision, hearing.

The catch with Medicare Advantage

Medicare Advantage plans come from for-profit insurance companies like United Healthcare — and they come with all the usual baggage.

Like denying care. An Inspector General’s report looked at a random sample of Medicare Advantage denials, and found: One out of every eight denials was for care that the plans are supposed to cover.

And limiting your options. Not just doctors, but hospitals. The main hospital near my 95-year old mom just stopped accepting United Healthcare’s Medicare Advantage.

Which leads to another familiar piece of insurance company baggage: They can change the deal on you any time. Stop working at your local hospital. Or just stop offering your plan, or reduce its benefits.

Traditional Medicare generally doesn’t come with these problems.

But choosing Medicare Advantage, you can get stuck dealing with that for the rest of your life. In most states, it’s a no-backsies situation.

Medicare Advantage, buyer’s remorse

Rick Timmins found a little growth on his ear, and thought “melanoma?” He says he has a family history with skin cancer, and his primary-care doc thought it was worth seeing a specialist.

But he says it took him six months of calling his Medicare Advantage plan — and calling, and calling— to get their OK.

“It was not a fun time,” he told me. The bump on his ear haunted him. “It was growing, and it was sore, and you know, I was frightened. It’s like you can’t think about anything else when you’re wondering about what’s happening with this little lump.”

He wanted to switch to traditional Medicare — but without a Medigap supplement, he wouldn’t be able to afford care. And a Medigap supplement seemed out of reach.

Because in Washington, like most states, companies can refuse to sell you a Medigap policy if you have a pre-existing condition.

“It’s sort of shocking, actually, right?” says Sarah Jane Tribble.

“The Affordable Care Act passes and makes it so that everybody with pre-existing conditions can get insurance no matter what — but it leaves out the people who might need that the most, who are 65 and older.”

Robert Wolpa in Texas also has buyer’s remorse with Medicare Advantage. He’s managing HIV, high blood pressure, and cardiac issues — and he finds himself on an exhausting, never-ending round of phone calls to get referrals and pre-authorizations.

He’s managing for now, but he says he can’t do that forever.

“I think to myself, you know, I’m 71,” he says. “I’ve got a little of the HIV [cognitive] crap. My short-term memory is gone.” He worries about what comes next.

Which it’s why it’s worth thinking about signing up for your older, probably sicker self when you enroll. And planning for all this years before you turn 65.

Like, if you hope to retire, you may want to think about: How can I plan to have enough income to afford one of those Medigap policies?

Oh boy, that’s scary. Now what?

First, congratulate yourself. You’ve just taken the most-important step: Starting to get educated. And you’ve faced the scariest part.

Next, we’ve got some resources for you. There’s stuff to read, and people to talk with — whether you’re trying to understand your choices, or to advocate for your rights if you get in a jam.

The Medicare Rights Center has amazing information online, and a hotline that takes 20,000 calls a year. We spoke to their director of client services for our episode and learned a ton. (BTW, she doesn’t think Medicare Advantage is always the worst choice. But tread carefully.)

Every state has an agency you can call to help you navigate your Medicare options. They’re called SHIP — for State Health Insurance Assistance Programs — the A is silent, we suspect. Head to shiphelp.org to get connected to the program affiliated with your state.

And: We’ll be back soon, with more Medicare stuff — less terrifying, but still super-important to know — and more resources.

Till then, take care of yourself!

— Dan

If you’re subscribed but First Aid Kit has stopped hitting your inbox, try whitelisting us, and make sure you’re subscribed. And you can contact us here.

Remember Thomas Sanford, the fourth-year medical student who created a one-page resource for dealing with medical expenses?

With help from some of you, he’s got a new draft — and a plan to keep making this tool better and better — hopefully with help from even more of you.

That virtuous cycle — and its potential to keep growing — makes this our favorite story of the year.

For today’s podcast episode, we caught up with Thomas to get the latest on this project and how you can help keep it going.

A med student’s idea to keep his patients from a “financial death sentence”

You may remember: Back in April, Thomas wrote to us asking if we had a “one-stop shop” handout with resources for managing high medical costs that he could share with his patients.

As he told Dan when they spoke this week, his patients come from one of the poorest sections of Brooklyn, and he knew that a visit to the hospital could be “a financial death sentence.”

He’d already started spreading the word about hospital financial assistance (aka “charity care”). But he wanted something more comprehensive he could share — maybe a guide to all our best resources.

So we gave it a shot. And we encouraged you to share resources we might’ve missed.

Fast forward to now, Thomas built on our initial draft, and thanks to your additions and feedback, it got a makeover, with a fresh title and some new content.

In this week’s mini-episode, listen to how Thomas is putting this resource to use, and how he hopes others will use it — and build on it.

Including you.

Let’s keep pushing this forward, together

We want to get this one-pager into the best shape — and into as many hands — as possible.

Here’s where you come in. Some possibilities:

• Print out the current version and pass it around: Download it right here.

• Make suggestions for the next version: Anybody can comment on this Google doc.

• Volunteer to pitch in: Got design skills? Editorial chops? Language skills, to translate it? Other ideas? Here’s a sign-up form.

It would be so cool to get as much feedback on this document as possible! Like…we’re dreaming 20 or 30 of you review it? 100?! As many as we can get!

And: you can actually spin up your own version of it.

Thomas is using a Creative Commons license — which means that you can make and distribute your own version. As long as you credit the original, and make your own version available to share under the same terms, you can re-publish it, update it, or customize it however you like.

For instance, you can add local resources. (If you work at a hospital, Thomas suggests replacing the Dollar For link with a link to your local hospital’s charity care policy. Or translate it into a different language.)

And if you do, please tell us — we want to hear about it.

Seeing this project come together — with our audience connecting and pitching in to build something — is a dream come true for us. And it’s a reminder of how much we can accomplish as a community. Let’s keep it going.

Now, some newsletter news, and a quick ask

As we’ve mentioned in recent First Aid Kits, we have a new-and-improved website, with features we’re really jazzed about, like Starter Packs — basically An Arm and a Leg-101.

And one of those new features: this newsletter! We’ve been working to move First Aid Kit from Substack’s email system to our own. So, starting next week, you should receive this newsletter from armandalegshow.com.

If change makes you nervous, don’t worry — everything else about First Aid Kit is staying the same.

To make sure First Aid Kit doesn’t land in your spam folder — please take a few seconds to whitelist us. Here’s how.

Meanwhile, we’ll keep posting our newsletter on Substack over the next few weeks, in case folks are having any technical difficulties getting our email and want a reliable place to find us.

And we’ll be following up with folks who don’t seem to be getting our newsletter after we migrate, so don’t worry about getting left behind.

Please reach out if you have questions about whitelisting or anything else about this transition.

That’s all from me. See you from dan@armandalegshow.com next week!

Best,

Claire

If you’re subscribed but First Aid Kit has stopped hitting your inbox, try whitelisting us, and make sure you’re subscribed. And you can contact us here.

When you tell people you work on a show about the cost of health care, you find out everyone has a story.

That’s what Dan said when he published his first episode of An Arm and a Leg, and it’s so true.

Since then, in the (nearly) seven years that Dan and the team have been putting out the show, we’ve managed to tell a tiny fraction of them. But a tiny fraction amounts to a LOT of stories — told across almost 150 episodes and dozens of these newsletters.

Over time, we’ve built up the contents of what could be a good beginner reference book on a handful of topics that come up again and again — like insurance denials and outrageous drug prices.

And we figure we could make it a lot easier to find answers to questions about those topics for anyone coming to us with a specific problem or interest, since 150 podcast episodes are a lot to dig through.

So here’s our first effort to assemble our best reporting on some of those topics into what we’ve dubbed “Starter Packs.”

Check them out, share them with someone who they might help, and tell us what you think.

Our five new “Starter Packs”

How do I shop for health insurance?

Compare plans, understand insurance lingo, and spot deals that are too good to be true. Bookmark this for open enrollment.

Help! I’m stuck with a gigantic medical bill

Strategies for fact-checking your bills, negotiating them down, and success stories to keep you motivated.

Help! Insurance denied my claim

The majority of folks who appeal an insurance denial win. We’ve got plenty of tips from people who’ve nailed it — and lots of encouragement.

Can I get my meds for less?

Our recent series about dealing with the high price of prescription drugs — chock-full of winning strategies, workarounds, and even a jingle to remember them by.

How to wipe out your medical bill with charity care

Find out if and where you qualify for free or discounted care —there’s a good chance you do at your local hospital — and how to get help applying.

We want you to plug in

What do you think of these Starter Packs? And what do you want to see next?

Tell us!

And hopefully, as we keep building this arsenal of knowledge, it will be those outrageous bills that “get packing.” (Haha?)

Your ever-aspiring punslinger,

— Claire

Subscribe now

If you’re subscribed but First Aid Kit has stopped hitting your inbox, try whitelisting us, and make sure you’re subscribed. And you can contact us here.

Hey there,

It’s no mystery: The size of your hospital bill depends a lot on where you get care.

You already know: You’ve gotta check that your insurance actually covers any hospital you might go to.

And you know: Even with insurance, bills can be huge.

A “safety valve” for a lot of people — one of the most important tools we’ve ever learned about — is charity care, sometimes called financial assistance: hospitals forgive bills — or give deep discounts — to people, based on income, at just about every hospital.

But every hospital sets its own charity care policy: What’s the income cutoff? Can people with insurance get charity care, or only the uninsured? The answers can be dramatically different from one hospital to the next.

Now, thanks to a new report and an interactive tool from a health care think-tank called the Lown Institute, you can look up which hospitals in your area actually have policies that would help you.

Meaning: You can see which hospitals are least likely to leave you stuck with a bill you can’t pay.

How a short distance can make a huge difference

The Lown Institute collected charity care policies from 2,500 hospitals across the country. (These are the same folks who brought us the Shkreli Awards, “honoring” health care’s worst examples of greed and dysfunction.)

Their findings show just how dramatic the difference between hospitals can be — and how clutch this information is.

As an example, they looked at two hospitals in Boston, The income cutoff for free care at Beth Israel Deaconess is almost three times higher than at Brigham and Women’s, just a few blocks away.

As Judith Garber, a Lown Institute policy analyst notes, this means “turning left or right at an intersection can be the difference between going into medical debt for thousands of dollars, or not.”

But Lown didn’t just compile this data. They made an online tool you can use, to decide whether to turn right or left.

Here’s how Lown’s charity care tool works

The first thing you’ll see is the start of a very-long list of hospitals. And notice: You can narrow it down by state.

For my home state, New York, it shows 99 hospitals. Now to evaluate them — to figure out which hospitals might actually consider me qualified for charity care — I need to do a little nerdy math.

You’ll see we’ve got columns here for “Free Care” and “Discounted Care” — but what do the numbers in those columns mean?

Nerdy answer: They’re income cutoffs, but laid out as percentages of the federal poverty level. So “100” here means: Exactly the federal poverty level. “500” means 500 percent: five times.

Hospitals list these percentages rather than just using dollar figures because: the actual dollar figure for you depends on how many people are in your household. For a single person, 100 percent of the federal poverty level is $15,650, but for a family of four, it’s $32,150.

So, to find the hospitals that might give you help, you’re gonna want to figure out where your household size and income puts you — using this handy calculator.

But wait, it’s not only about income cutoffs

Lown also gives a “scorecard” for each hospital, with more details. Here’s an example of the scorecard for NYU Langone-Suffolk, where I’ve circled a key detail:

That question, “Are underinsured patients eligible for FA?” translates to:

If I have insurance, can I still qualify for charity care?

…and here the answer is “yes.”

Other details here could also be worth looking at, including the last question in that screenshot: It says “only patients residing within state” qualify for charity care at this hospital. If I live in New Jersey, a couple hours away, I’d be out of luck here.

A couple of caveats (of course):

1. Hospitals can make lots of carve-outs to their policies, and these summaries from Lown may not capture all the fine-print details.

2. The Lown tool is based on a one-time snapshot — what these policies looked like in spring 2025. Any given hospital could change its policy at any time.

So you may want to do some additional fact-checking: Google [hospital’s name] + “charity care policy” to find the current policy, read the fine print, and call the hospital if you spot ambiguities.

Ask for “charity care” by name. Right away.

This is a big, red-light warning from the folks at Dollar For, a nonprofit that helps people access charity care. They’re basically the country’s leading experts, for if/when you ever do get a hospital bill.

As Dollar For’s founder Jared Walker told us, “financial assistance” may technically mean the same thing as charity care — like, they show up interchangeably in government policies — but folks at hospital billing offices don’t always think so.

A billing rep may say, “Yeah, we’ve got great financial assistance options…” and then steer you to a payment plan — often administered by a third-party, like CareCredit or Access One.

Do not let that happen. As Jared’s colleague Eli Rushbanks told us this week, getting signed up for one of those third-party plans could make it almost impossible to apply for charity care later.

Financial assistance staff need a “bill” to forgive, and once a third party has taken over the bill… sometimes the hospital says they can’t access it anymore.

“The patient’s financial assistance application is then effectively denied,” Eli wrote, “on the basis that there’s no financial assistance to grant without an outstanding bill.”

So when you’re ready to apply for charity care, call the hospital’s billing office and ask about charity care by name.

And whatever you do, don’t agree to a payment plan managed by a third party like CareCredit without first applying for charity care.

And in general beware of these products because, as we’ve reported on the podcast, while they sometimes tout “zero-interest” terms, if you miss a payment or don’t pay it off quickly enough, you can get socked, hard.

If you need assistance with your charity care application — especially if you run into a sticky situation — Dollar For has staff who can help you, for free.

Finally, if you get a charity care application denial, here’s a template a listener made for appealing.

That’s all from me for now.

— Claire

Subscribe now

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Hey there,

Like we said last month, Obamacare will get a lot more expensive next year — and since then, we’ve learned that workers with employer insurance will get socked too.

In this week’s new podcast episode, you’ll hear the Arm and a Leg team personally confront 2026 health insurance prices. We’re a case study. And we’re here to pass along what we’ve learned.

Quick recap: There’s a double whammy cooking for Obamacare plans. Insurers plan to jack up premiums, while at the very same time, federal subsidies are slated to get a lot less generous.

Meaning: Lots of people will be on the hook for hundreds of dollars more, every month.

Including my colleague Emily Pisacreta — unless we can get her on insurance through An Arm and a Leg, which would take money we don’t have (yet).

So you’d better believe we’ve been learning everything we can. You can hear our saga on the podcast.

Meanwhile, here’s what you need to know, including political news breaking this week, and specifics about how to see what you may be in for, and where you might be able to find help.

But first: real quick — we can’t do this work without the support of our audience. If you’re reading this and finding any of it useful, would you consider chipping in to support our work?

Support us

Congress could avert the double-whammy, if they act fast

Expiring federal subsidies play a huge role in the double whammy. If Congress extends them soon, it could make a huge difference.

Here’s the background: In 2021, Congress added new “enhanced” subsidies to Obamacare, making policies much more affordable for pretty much everyone.

Millions of middle-class folks had been locked out of subsidies entirely by income caps; the new subsidies helped anyone who would be paying more than 8.5 percent of their income for a basic plan.

Enhanced subsidies also meant millions of lower-income folks could get policies for ten bucks a month, or even zero.

But those subsidies were temporary — just four years — expiring in December.

And: The expiring subsidies are a big reason insurers plan to jack up rates.

Insurance companies figure that fewer subsidies mean a lot of healthy people will just skip insurance, so the remaining “risk pool” will be more expensive — a heavier burden on people who need to actually use health care.

But just this week, the Congressional Budget Office said insurers might roll back those increases — if Congress extends the subsidies by September 30.

The stakes are high. Also this week, an analysis from the Urban Institute predicted that if the subsidies expire, 4.8 million people would drop coverage in 2026.

So, what’s Congress gonna do?

Here’s all I know: In July, when we started looking at this double-whammy situation, experts were saying, basically, Congress won’t do s—.

Republicans had just passed President Trump’s very expensive tax cuts, so they wouldn’t consider spending new money on subsidies.

By August, news reports said Republicans were “split” on the question — because so many of their constituents would get socked.

By mid-September, some Republicans were actively working on legislation to extend the subsidies.

And this week, more news. Democrats have threatened a government shutdown unless the subsidies get extended.

(Congress has until September 30 to pass a spending package, or else the government shuts down.)

All that said, I’m not holding my breath. Republicans have reportedly “dared” Democrats to shut down the government over the issue.

Meanwhile, the Trump administration has announced an alternative to newly hyper-expensive Obamacare plans:

Allowing more people to sign up for “catastrophic plans” — which could be less expensive per month but offer a lot less coverage. Julie Appleby at KFF Health News has lots of details.

Meanwhile, here are some potentially useful resources.

Get your numbers, and (maybe) find a navigator

If you or anybody you know may be looking at Obamacare for 2026, this calculator can show you how ugly the numbers could be.

In our podcast episode, you’ll hear Emily consulting an earlier version — the data behind the page got an update last week — and although the output might be scary, it’s better to know the deal.

You’ll also hear Emily get super-valuable help from an Obamacare “navigator.” These are government-funded workers who help folks choose Obamacare plans and sign up for Medicaid.

Bad and less-bad news here, depending on where you live:

Bad: Earlier this year, the Trump administration announced a 90 percent cut in federal funding for navigators.

Less-bad-for-some: About half the states fund their own navigator programs, so the federal cut won’t affect them.

Those are the states in grey on the map below, from KFF.

Also: Maybe you can help.

Emily talked with Nicholas Riggs, who runs North Carolina’s navigator program. In the face of that 90 percent cut, he’s recruiting volunteers.

If you’re in a state where navigator funding has been cut, and you’re somebody who’s really good at, like, organizing in-person gatherings with your neighborhood or place of worship? It sounds like your skills could be useful.

Finally…

Yes, we’ll do more advice columns

After last week’s experiment, where I answered a question from an Arm and a Leg listener, lots of you wrote in to say, “Keep these coming.”

Glad to! And if you want to write in for advice, here’s the place to do it.

Catch you soon —

Dan

P.S. One more time: Donations from readers and listeners are our number-one source of income. If you’re not a supporter yet, help us keep a good thing going.

Support our work

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Hey there —

I get a lot of questions from An Arm and a Leg listeners. Sometimes I write back with advice. So: Why not share? Welcome to an experiment: Our occasional advice column!

Maybe let’s call it: Can they freaking DO that?!?

Disclaimer: I don’t know everything, I’m not a lawyer, and I haven’t done new reporting for this. It's the kind of advice I’d give a friend.

Or, in this case, a listener named Chris.

Q: Can they charge me $47,000 for their mistake?

I had an emergency appendectomy. The hospital rang me up for about $47,000 — but, insurance denied the claim because they say the hospital didn’t submit it to them until eight months after the fact — beyond their 60-day “timely filing” limit in the contract [between the hospital and the insurance company].

After that, the hospital started billing me.

I have spent hours and hours on the phone over the last two months with various people in their billing department. I followed their recommendation to send a letter, and an email, requesting that they write off these charges since it was their billing error — and nothing has been fixed.

Now they’ve sent me to collections.

What do I do now? Do I sue? How can I sue? Help!

Chris

A: Don’t run for a lawyer (yet)

Chris, thanks so much for writing in — and YIKES.

I think you're zeroing in on the right question, which is: How can you demand redress?

Put another way: Where’s your leverage? How can you get them to see they’re better off dealing with you in good faith, versus… getting themselves in actual trouble?

I don't think you need to run out and hire a lawyer. But there's a bunch of homework to do.

Start with your insurance

Because it's their job to protect you from getting unfairly harassed like this.

Sounds like the hospital promised the insurance company — in a contract — to submit bills within 60 days.

That contract probably does not say, “and if we’re late on that, we'll just go after Chris.”

No. I'm thinking it says, "If we don't get you that bill on time, that's just too bad for us."

So: the insurance company has a right — and an obligation to you — to tell the hospital where to stick that bill.

So ask your insurance company: What's *supposed* to happen if a hospital doesn't submit a bill on time? What's their process for getting things fixed? Can they tell the hospital to just knock it off, already?

And while you’ve got them, you may as well ask: If the hospital had submitted the bill on time, what would you have been on the hook for?

…because when this gets fixed, you’ll probably owe that amount.

If your insurance won't cough up the info and won’t go to bat for you, get help. If you get your insurance through work, call HR. Otherwise, ring up your state insurance regulator.

Dispute the bill in collections

Meanwhile, you've got the hospital siccing a collection agent on you. That’s not right.

Notify the collection agency that you're disputing this debt, as described in this recent First Aid Kit — which includes a dispute-letter template. (While you're at it, send a copy to the hospital billing office.)

Document your efforts to get the hospital to see the light on this. If you've written to them, attach copies of previous correspondence. If it's been all phone calls, document them: You called them on this day, at that time, etc.

If you haven't been logging calls — keeping a set of notes with times, dates, who you spoke to, and where things stood at the end of the call — start now.

Let the hospital know: They could get in trouble

Your state’s consumer-protection office might take a dim view of what the hospital is doing here.

I mean, I'm not a lawyer, but I'm pretty sure there are laws against chasing you for money you don't actually owe.

Look up that consumer-protection office here. If you can talk with someone there, great. If your state’s consumer-protection laws are easy to find online (and understand), also great.

(If not, consider calling your local public library. Seriously, librarians are amazing at helping dig up useful information.)

Once you’ve got some sense of your legal rights — from the hospital’s contract with the insurance company, from your state’s consumer-protection laws…

Start writing letters. To the hospital, to the collection agency — saying: Let's get this settled before I have to complain to regulators about this. (When you write to the hospital, maybe cc the General Counsel's office.)

Let them know how you expect things to go, and indicate — subtly but clearly —that you know what kind of trouble they could be in and why.

And make it all as confident and calm as possible. I'm thinking of something the legal expert Jacqueline Fox told me once:

The person who gets the letter has to make the decision: “Do I ignore this, or do I bring it to my manager?”

And if I was that person and [the letter-writer] was very calm — just saying, "this is happening, and it's starting to look like this [legal issue] and I want this to be handled according to your processes," that's the part I'd find alarming.

If I was that person, I would either make sure it's handled according to my processes, or give my manager a heads up: that there's a grownup who seems somewhat irritated.

Somehow, we never actually used that tape, even though I think about it all the time — until now. Thanks for the chance to bring it back.

I hope all that is helpful. Lemme know, and take care of yourself.

Whaddya think?

This was our first stab at running an advice column. How’d we do? Anything we missed in our advice to Chris?

And: Any reason not to keep experimenting with this format? I kinda like it.

Thanks! Catch you soon,

— Dan

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Avid “First Aid Kit” readers might remember that in the spring, we wrote about a med student named Thomas who wanted a one-page resource guide — and we asked for your help in drafting one.

You guys came through, and Thomas put your contributions to work. He’s got a new draft, and we’ve got a new opportunity for you to weigh in — and help take it to the next level.

Thomas’s project (1.0)

Quick recap: Thomas told us that after hearing our show, he wanted to spread the word about charity care (AKA financial assistance that most hospitals are required by law to provide).

So, Thomas got into contact with Dollar For, a nonprofit that helps people apply to charity care, and worked to distribute more than one thousand of their cards to hospitals around Brooklyn.

But he wanted to know: Did we have a one-page handout of our own, with other under-the-radar resources for people staring down giant medical bills?

We didn’t… but we decided to try making a very rough draft of one, and asked for your input. You shared some great suggestions.

And now… we have more from Thomas.

Thomas’s new and improved one-stop shop

Thomas gathered our suggestions and yours — and turned around a brand-new printable resource guide for patients.

We were delighted, and now we want to share that guide — and get your help with some finishing touches.

Thomas’s new handout includes nine resources — Dollar For is on there of course, along with NeedyMeds, an online directory for programs that could get you a discount on your prescriptions if you qualify.

And this newsletter. And two guides that you pointed us to.

And you’ll notice: Everything’s got a QR code, another of your suggestions.

We love it, and it’s already in action: Thomas told us his school’s clinic already has it posted.

Now here’s where you come in:

Help take it to the next level

Thomas is a med student, not a designer. The current version is functional, but he thinks somebody with graphic design skills could make it even more usable — clearer, more readable, and maybe more eye-catching.

“Somebody with graphic design skills” isn’t us. But maybe it’s you? And there are a few other kinds of help that you may be better-suited to offer than we are.

For instance, Thomas wants to translate this thing into Spanish, Mandarin, and other languages.

And, assuming multiple people are interested in pitching in — which we definitely hope will be true — well, organizing and wrangling a community of volunteers is a skill of its own. Maybe one you’re great at?

And there may be jobs and skills we’re not thinking of. So…

If you’d like to pitch in, please go ahead and fill out this Google form with your name, contact info, and how you’d like to get involved. We’ll share the results with Thomas.

This project is so exciting: Something that anybody can print up and distribute, around the country. We can’t wait to see how it develops.

And a reminder: This newsletter is moving off of Substack!

Luckily, no U-hauls required — this move is virtual.

But we want to give you the heads up that sometime soon — probably in the next week or two — this newsletter will no longer come to you through Substack.

We’ve built a home for it on our new website, bringing all our resources into one place, and — encouraged by your feedback — we’re moving the email-sending operation there too.1

And don’t worry. If you’re subscribed, this email should still come straight to your inbox after the move — just under the sender name “dan@armandalegshow.com.”

To get ready and to make sure your email’s spam filter doesn’t block this newsletter, maybe take a minute to “whitelist” us by adding dan@armandalegshow.com to your contact list.

And if you end up not getting our email anyway… Please reach out to us here.

We’ll still keep our Substack page up for now — and we’ll keep you in the loop throughout this transition.

That’s all from me this Thursday.

— Claire

Subscribe now

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Hey there —

Over on the podcast, we’re bringing back a story from our archive that’s one of my all time favorites — and that drives home a lesson about how health insurance really works for most people.

In 2021, we profiled someone who probably knows more than anybody about what it takes to fight insurance and win.

Laurie Todd fights insurance denials for a living, working under the moniker “The Insurance Warrior.” Her speciality: writing appeals when insurance companies deny high-stakes, high-dollar treatments.

Her first victory – which we chronicled in an episode tracing her origin story – was fighting to get coverage for her own life-saving cancer surgery. Since then, she claims to have notched victories for more than 200 other people.

Today’s podcast goes deep on one of Laurie’s early cases— super-dramatic and super-instructive. It taught Laurie one of the weirder truths about health insurance in America:

Fighting your health insurance often means fighting… your employer.

I’ll unpack that weirdness in a sec, but — just to tease today’s story: In this case, that employer was a $61-billion-dollar company.

You can listen here, or wherever you get your podcasts.

Wait, why would fighting my insurance mean fighting my employer?

…Cuz your employer might be your insurer.

OK, what?

Yeah, so, if you get your insurance through work, you probably have a card that says Blue Cross or Cigna or whatever — but more often than not, your employer is the actual insurer – meaning: the one who ultimately pays for claims.

Your employer pays Cigna or United whoever to administer your health plan — decide which providers are in-network, send out paperwork, approve and deny routine claims, all that stuff — but when it’s time for the health plan to send a check, it’s with the employer’s money.

The nerds in charge call this a “self-insured plan” or a “self-funded plan.”

… versus what we think of as normal insurance, which the nerds call “fully-insured plans”: where the insurance company collects monthly payments — premiums — and uses that money to pay for claims.

But “self-funded” plans are the norm for bosses. About two-thirds of workers – and almost 80% of workers at big companies– are in plans like these. (To check if that’s you: it might actually say it right on your card – or you might have to dig up your policy, or call HR.).

And here’s why you want to know — why this distinction between self-funded vs. fully-insured matters.

In a self-funded plan, you have fewer protections

Because state insurance regulators don’t have any jurisdiction over self-funded plans.

So if you’re in one and you run into a problem, your state regulator can’t help you..

Instead, the job of enforcing your rights falls to an office at the Federal Department of Labor that a 2023 government report called “significantly underfunded” — and has lost 20% of its staff this year.

The federal law that governs all this, called ERISA, also gives you fewer rights than state insurance regulators do.

A law firm that specializes in fighting insurance has a webpage with the headline: How to Talk to People About ERISA Health Insurance Denials. The first answer, in big type: You start with a hug.

Under ERISA, it says, “employer-sponsored health plans were somehow able to slither into protections that were initially designed for union pension funds.”

…which seems pretty different, yeah?

Yikes, where does that leave me?

In an absolute best-case scenario, your employer steps in and fixes the problem, telling the insurance company administering their plan: “No, we’ll pay this one.”

We talked once with Steve Benasso, an HR guy who prided himself on being a bulldog, fighting bogus insurance denials on behalf of his colleagues.

Steve gave what’s still one of my favorite pieces of advice to anyone fighting over a medical bill or an insurance denial:

“You have to be willing to stand up for yourself,” he said. “You have to be willing to tell people in authority, sometimes, that you believe they’re wrong.”

But not all of us get to work with someone like Steve Benasso.

In that case, especially if the stakes are high, you may need to go to war. You’ll want all the lessons you can get from people like Laurie Todd, from today’s podcast.

And it just so happens: We’ve just compiled a new Starter Pack with the best advice we’ve gotten on this topic — on the podcast and in First Aid Kit — our website, right here. You may want to bookmark it, just in case.

While we have you here: We could use your help

If you’re a fan of our show, or this newsletter, you know we’ve been up to A TON this year.

We took this newsletter-thing weekly, added starter packs to our website, and put together a whole playbook to help you deal with the high cost of prescription drugs.

To keep that momentum going, we’re looking to raise $75,000 by the end of the year.

And that’s where you come in.

Because: Donations from people like you are what powers our work.

So here’s our first goal: We want 100 people to make their first-ever donation September 5.

Could that be you? Please go ahead and chip in.

Donate now

Thanks and catch you next time.

Until then, take care of yourself.

– Dan

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By far the most powerful piece of information Dan and our team at An Arm and a Leg have discovered in the past six years is that if you have a medical bill from a hospital, there's a really good chance you can get it written off — either partially or entirely.

That’s thanks to charity care — financial assistance that most hospitals are required by law to offer to their patients below a certain income level.

Different hospitals have different requirements, but it’s estimated that almost 60 percent of us might qualify for help.

Not nearly that many people actually get that help. Partly because lots of folks don’t know they might be eligible or how to apply. Jared Walker’s group Dollar For has been doing a lot to spread the word and provide help — their tools are terrific — and we’ve boiled down some of their top advice.

But then, some people don’t get the help they need because the hospital doesn’t say yes.

In that case, some self-advocacy can go a long way. An Arm and a Leg listener named Clara managed to get over $8,000 worth of bills down to $1,150 through charity care despite some obstacles.

It took persistence, effort, and some advanced strategies — that she shared with us on the podcast last year. She also shared a template of a letter you can use.

You don’t have to do it all on your own. The staff at Dollar For offer individual help, for free. But we think these kinds of self-help tools are worth spreading around.

Don’t give up, even if you’ve made a mistake

That $8,000 pile of bills came from three separate hospital visits Clara's family had needed in less than a year, so staying organized was important. And so was persistence.

Especially because, as she told us, the hospital itself didn’t provide tons of support in the process.

“A lot of phone tag,” she recalled. “And I don’t know if the bill pay phone lines are staffed better than the financial aid phone lines. But, you know, you get an answering machine a lot. You have to call back. The person doesn’t remember you. They’re not able to link your account.”

She suggests keeping a paper trail of your aid applications and appeals — and to call the hospital’s financial aid department by phone to check on your applications, along with writing down the name and email of whoever you speak with.

Still, at one point, she did miss a deadline.

And, she didn’t give up. She reached out to the hospital’s financial assistance department — and they said not to worry about it.

A denial — or a lowball offer — is not the end

Unfortunately, once you’ve applied, you may not get the answer you want.

According to a recent survey by Dollar For, more than 40 percent of people who applied for charity care did not get approved. Some never heard back at all.

In Clara’s case, the hospital approved her family for charity care — but not nearly enough to actually make her bills affordable. The initial offers left her family on the hook for more than $6,000.

Clara decided to appeal.

She ferreted around the hospital’s website for information about how to do that. When she didn’t find everything she needed, she called the hospital’s financial aid office, which gave her the contact info she needed to send an appeal letter.

Clara’s genius charity care appeal letters

Clara ended up making three appeals — one for each hospital visit — which meant writing three letters.

The letters straightforwardly make a request — and go on to describe the financial strain the family was facing.

“Paint the picture of this bill in context of everything else,” she suggests, like rent, childcare, or other bills you owe.

For example, Clara wrote:

While I am fortunate to have a steady income, our family is on a tight budget as both myself and my husband work for public-interest nonprofits. Our monthly costs include rent for a one-bedroom apartment in Washington Heights and full time daycare for Isaac (now 4 months old) and our two-year-old daughter, which we need to accommodate two working parents.

And then she made an offer. Clara estimated she could pay $500.

But in doing so, she also expressed gratitude for the hospital’s care. (A real object lesson in keeping cool while dealing with medical bills.)

In the template Clara created for An Arm and a Leg listeners, she suggests something like:

“I can offer [insert dollar amount] over 18 months for the excellent care I received, and humbly request that you waive the rest of the bill using financial aid coverage.”

Ultimately, the hospital honored her request, all three times.

Here’s Clara’s template, plus her tips, and a redacted version of an appeal letter she actually sent.

Overall, Clara’s story shows that some hospital charity care programs have more flexibility than they may initially offer, and that asking for more help can work.

And again: If all this sounds overwhelming, you don’t have to go it alone. The staff at Dollar For will step in to help.

We have more tips on applying for charity care in the show and this newsletter, along with stories from listeners that we, honestly, find inspiring.

For instance: One listener who drafted the American Medical Association’s new resolution on financial assistance, or a reader who organized a local clinic to help folks sign up for charity care.

That’s all from me for now.

— Claire

If you’re subscribed but First Aid Kit has stopped hitting your inbox, try whitelisting us, and make sure you’re subscribed. And you can contact us here.

Health insurance sucks. We’ve always said it. And this year it’s going to be even worse. Whether you get it from work or the Obamacare marketplace, it’s getting more expensive.

But those Obamacare plans are getting hit with what KFF Health News calls a “double whammy”: Double-digit rate hikes from insurers combined with lower subsidies mean everyone will pay more, and some people could see their premiums double.

And because of massive federal cuts to health spending, there will be less help for signing up. It’s bad news — no way around it.

Here are our best tips on how to prepare for this new, scarier enrollment period — and how to get a sense of your costs for next year, so you can start budgeting.

You might be in for a big spike in costs

How big? A lot depends on your income, and where you live.

Where you live affects how much your premium could jump: This analysis estimates a 20 percent average increase, but specific numbers range from 10 percent to 50 — a huge spread — “depending on the carrier, the state, on the market, says Sabrina Corlette, founder and co-director of the Georgetown Center on Health Insurance Reforms.

Then there’s your income: Unless Congress acts to bring back the “enhanced” subsidies — which it could still do, but maybe don’t hold your breath — a KFF analysis predicts people will pay 75 percent more on average.

But subsidies — “enhanced” or regular — are tied to income: At the low end of the income scale, folks now paying zero dollars a month could be looking at paying about $70 a month.

And people with incomes above 400% of the federal poverty level — that’s about $62,600 for a single person or $128,600 for a family of four — would no longer qualify for subsidies at all. (You can check if that’s you here.)

That means paying sticker price for insurance — which can be $10,000 a year per person, or more.

You can estimate how much your monthly costs will go up if subsidies expire with this calculator (scroll to the bottom of the page). Here’s an example:

These are the results when I put in my info: an individual living in Brooklyn, New York, with an estimated annual income of $45,000. Without the enhanced subsidies, my costs are estimated to go up about $100/month, from $223/month for a silver plan to $323/month.

One cost-crushing tool isn’t going away: For folks with lower incomes, something called “cost-sharing reductions” still exist. Those can make a big difference by lowering the amount you have to pay out-of-pocket — like for copays and deductibles.

These apply to you if you earn less than 250% of the federal poverty level. To get the cost-sharing reductions, you have to sign up for a Silver plan.

Sign-ups start November 1. Sabrina says folks who are already enrolled should get the gory details — premiums for 2026 — sometime before then. Either way, get an early start, because…

If you need guidance, you may have to wait (and wait…)

Earlier this year, the government slashed the budget for navigators — trained insurance helpers who offer unbiased information about plans in your area.

Now, with fewer navigators, it may take longer to get someone helpful on the phone. (You can, however, contact a licensed broker — but be aware that brokers get commissions from insurance companies.) So, Sabrina says get the ball rolling as soon as possible.

Unfortunately, this isn’t even close to everything

It’s not just navigators — new government regulations and the passage of the “One Big Beautiful Bill Act” mean lots more cuts — like to coverage for lawfully present immigrants, DACA recipients, and providers like Planned Parenthood.1

And in years to come, there will be more paperwork required, too — pay stubs, birth certificates, etc.

But for now, you’ve got the basics. Get ready to pay more and start scoping out your options now.

If you have more questions — or insights — about enrollment in 2026, please send them our way here.

And we have a new Starter Pack with all our previous tips for shopping for insurance on our new website — including some new hustles to watch out for.

That’s all for me. Stay tuned for our next episode: My colleague Emily Pisacreta is going through this planning process right now, and we’ll bring you along for the ride.

— Claire

If you’re subscribed but First Aid Kit has stopped hitting your inbox, try whitelisting us, and make sure you’re subscribed. And you can contact us here.

Hey there —

Here’s one way today’s podcast episode is timely: It’s not too early to start planning on how to avoid a 2026 health-insurance nightmare. Because, there will be some.

It looks like premiums will be going up a LOT for Obamacare plans — like 18 percent, on average. Which is huge.

Honestly, that’s a nightmare of its own, and next week my colleague Claire Davenport will have a guide to what’s new for 2026.

But today’s show offers a vivid reminder: Shopping for insurance outside the world of healthcare.gov puts you in a world of hustlers, and opens you up to new worlds of hurt.

New Yorkers Sarah and Joe Strohmenger thought the plan a telemarketer offered them would be a good deal: Their doctors, meds, tests? All covered.

And insurance, they figured, was a regulated business. “We're thinking it's monitored,” Sarah told me. “We had no clue that this was kind of like a free for all.”

Free for all is right. Not only did the plan they bought leave them on the hook for thousands of dollars in medical bills, but they found themselves with no legal recourse.

As Bloomberg News reporters Zach Mider and Zeke Faux discovered: The plan Joe and Sarah had paid for wasn’t even insurance.

What Sarah and Joe got instead — a skimpy health plan tied to a “job” they had no idea they’d signed up for — fell into a legal grey area that no one regulates. Not states, not the feds.

It’s a wild, infuriating, and honestly fascinating story: The guy behind what Bloomberg calls the “fake jobs” is a former TV sitcom writer who thinks he’s actually solving an important problem.

And this is just one especially weird example of what can happen when you open yourself up to buying health insurance over the phone, after turning to Google.

Zach and Zeke published a follow-up — about a wild setup involving deepfakes of celebrities like Taylor Swift and Steve Harvey. The stories ran under the heading “Health Care Hustlers.”

“In reporting both of these stories,” Zeke told me, “I think what we learned is that there is kind of a subculture of call center operators who have turned what seems like a pretty boring business selling health insurance into a get-rich-quick kind of operation.”

Here’s what to do instead

Take a minute now to plan for your 2026 insurance — whether you get it through work, or you have to buy it on your own — by doing some homework.

Even under less-nightmarish circumstances, shopping for health insurance is wildly complex. There are a million arcane terms to learn. And most of us need help setting up the math. You can hear my family struggling with it in an early episode.

AND… we’ve published some pretty good guides to figuring all this out. And we’ve pulled them together in a Starter Pack on our new website.

Seriously, the choices this year are not going to be pretty. Most of us will have some unpleasant decisions to make.

We may as well brush up on the math and vocabulary ahead of time. I’m not saying put down your beach reading right now, but don’t wait too long.

So that at least when we have to make those choices, we know we’re doing them with the best information possible. And we won’t have to go through math and vocab lessons at the same time.

And again: Claire will be here next week, with answers to some of the 2026-specific questions.

Till then, take care of yourself,

— Dan