How to pick health insurance — in the worst year ever

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

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

Dan hosting: And people were pissed. Here’s a couple examples from our social-media feeds… 

TikTok user hunteralexanderpowell: eight Democrats caved and betrayed the American people tonight

TikTok user shaneechchi: The Democrats caved. The Democrats caved! What? I have tried to calm down so many times to record this video, but Senate Democrats…

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

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

Dan hosting: Yeah. News reports pretty much all say: That vote will fail.

But even if they’re wrong, even if some unexpected deal gets made, expect nightmares. Logistical nightmares. Tech nightmares. Julie Appleby is a reporter with our pals at KFF Health News.

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

They were like: Well, we’d have to take our websites down to plug in the new numbers. 

Julie Appleby: And that could take maybe up to a week.

Dan: Yeah, a week. Julie says that took her by surprise.

Julie Appleby: I guess I mistakenly assumed, naively assumed that, oh, it’d be pretty easy. Let’s just, you know, program these numbers in. It might take a couple hours or whatever, but no, it’s not just a simple let’s throw a switch and change all this stuff…

Dan hosting: And there’s a ticking clock: If you want an Obamacare plan that starts covering you on January first, you have to sign up by… December 15. And again, IF there’s a vote to do any of this, it’s not supposed to happen until December. Tick-tock… 

So look: Nobody can predict the future, but if you’re looking at Obamacare for 2026: Don’t count on those extra subsidies being there.

Meanwhile, premiums are going up — both for Obamacare plans and for employer-based insurance.

We’re gonna spend the rest of this episode looking at: OK, now what? It’s the worst ever year to choose insurance. What do you do? We’ll hear from a listener who wrote to us asking for advice, and we’ll look at what next year looks like for ourselves — for me and my colleague Emily Pisacreta. 

There are folks who have it worse than we do. Millions of people just won’t be able to afford insurance at all for next year. But our stories give a sketch, a little sample — and some lessons and tools that I hope will come in handy for anyone asking the same questions we are.

Like a lot of our stories — like our whole beat– there’s no happy ending here. This absolutely sucks.

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

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

Let’s pick up where we left off a couple of months ago: With this show’s senior producer, Emily Pisacreta. 

Dan hosting: Hey Emily.

Emily hosting: Hey Dan.

Dan hosting: So, let’s recap… 

Emily hosting: Yeah, so before… I had insurance from another part-time job. But that job ended over the summer.

Dan hosting: And An Arm and a Leg has always been so tiny, I never thought about budgeting for anybody else’s health insurance.

Emily hosting: So I had to look for Obamacare. And I ended up getting help from the absolute best person: Elisabeth Benjamin. She’s Vice President of Health Initiatives at the Community Service Society of New York. 

Dan hosting: She has been one of our go-to sources for years–  because her fights to protect New Yorkers from medical debt are epic.

Emily hosting : And as it happens, she’s also a navigator for Obamacare — she helps people choose and sign up. She invited me over to look at my options.

Elisabeth Benjamin: Ok, so ready?…

Emily hosting: The good news: I qualified for a subsidy.

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

So, last week, we did– just a couple days after those Senate Democrats had folded on the enhanced subsidies. 

Elisabeth Benjamin: It’s quite clear that the enhanced premium tax credits are gonna sunset. Right?

Emily: Yeah.

Elisabeth Benjamin: Yeah. Which is really horrible for patients.

Emily: Are you surprised or did you sort of see the writing on the wall?

Elisabeth Benjamin: I find understanding Congress and the federal government and what they’re gonna do really challenging. I would’ve thought people would’ve wanted to do something, but it’s, it’s hard when people aren’t getting SNAP benefits and planes aren’t flying. And for me I would’ve thought that they would’ve been able to come up with a compromise, but they didn’t. So…

Emily: Yeah. 

Elisabeth Benjamin: So, you know, I don’t know. All right. Lemme show you your thing. 

Emily: You wanna share your screen? 

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

Emily hosting: So we kinda knew this was coming. I make a little more than 400 percent of the federal poverty level, which means I don’t qualify for that enhanced premium tax credit anymore. 

Elisabeth Benjamin: You are being impacted by the expiration, like you are going from. Spending whatever it was, 400, $400 a month to $800 a month.

Emily hosting: Actually it’s going from $496 to $867. And all this for what’s called a Silver Plan. You know, not platinum, not gold. 

Elisabeth Benjamin: You’re not talking about Cadillac coverage here. You have a big deductible.

Emily hosting: Yeah… that’s $2500 before I can afford to see a doctor in person. A doctor who’s in-network. In an itty bitty network. I kinda wondered what I would get if I leveled up. 

Elisabeth Benjamin: So you wanna do the cheapest gold or like a mid price

Emily: Yeah. Let’s just see what the cheapest golds look like.

Elisabeth Benjamin: So the cheapest is 1100. $1,100. So that’s a lot. 

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

Elisabeth Benjamin: Just walking into an emergency room in New York City is like $10,000. So you’d be basically paying your whole emergency room visit. Whereas right now you have real protection, you only have $500…

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

Dan hosting: Yeah. That’s just one way where you live really matters.

Emily hosting: Yeah and I’m never leaving, I’m like the worst kind of New York chauvinist. But the cost of living here means this premium increase is gonna really hurt. I’m gonna need another job.

Dan hosting: Yeah, but I wanna keep you in this one. And we are working on a plan there. We’ll come back to it later. 

Emily hosting: Mmhm.

Dan hosting: Meanwhile, you’ve given us a snapshot of Obamacare.

Obamacare plans aren’t the only place where costs are going up. According to a survey of 1,700 businesses, the rate hikes on employer plans are the biggest in 15 years.

And you know who’s on an employer plan? My family. My wife and I both have small little businesses, and we’ve been able to buy small-group coverage for ourselves that way — which means we do get to choose from plans that aren’t on the Obamacare exchange. 

So, here’s a little heartwarming scene from my house — me showing my wife Devorah what our health insurance is going to cost for next year.

Devo: All right.

Dan: Make sure we’re recording. Let’s see. Yep. Here we go. Alright, so let me just show you what I have been looking at. 

Devo: Alright.

Dan:  And be aware that it super sucks. 

Devo: Alright.

Dan hosting: And here’s what I showed her: Our insurance plan is going up by 500 dollars a month in January. Six thousand dollars a year. 

Devo: I’m not allowed to say bad words, right? 

Dan: You’re totally allowed to say, are you kidding me? Bad words are very appropriate. 

Devo: Bad words are forming in the thought bubble over my head. 

Dan: You can say them all you want 

Devo: Okay. Fuck. 

Dan hosting: Absolutely fair. The new total for our plan is terrifying.. And — for reasons I’ll get to — that plan still looks like our best option.

Meanwhile, we’d heard from a listener — Jess lives in Indiana. She asked us to just use her first name, to protect her family’s privacy.

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

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

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

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

Dan hosting: And she says that limited list of doctors, it’s got a lot of turnover.

Jess: So like, we’ve been through how many doctors in the past five years? Then I know that if anything bad does actually happen, I still gotta come up with like $17,000 to like pay those bills, on top of everything else. So sometimes I’m just wondering like where, like with a system that doesn’t make any sense, where’s the line where for… I just feel like a lot of people are gonna be thinking about this, this year. Like, what? I’m gonna keep the money, I’m gonna put it in the bank and with people losing their jobs and stuff too, like maybe it’s time to just bulk up your savings. I don’t know.

Dan hosting: Jess and her husband run a small business. It hasn’t been a great year, and next year could be kind of dicey. On the other hand, her dad survived a major bout with cancer earlier this year. That experience had already been noodging her toward pressing the button: paying the extra for insurance. And then a little after she wrote to me.  

Jess: I was like visiting dad, this fall, So it had been long enough that he actually got the like ex– like I think it’s probably the explanation of benefits or whatever…

Dan hosting: Yep, explanation of benefits: That’s the insurance paperwork that shows the total chargesfor all that cancer treatment, and what the insurance company paid.

Jess: And he’s like, do you wanna know how much that cost? it was a million dollars. And I was like, okay, I guess I’m getting health insurance again this year. 

Dan: Oh my God. Wow.

Dan hosting: She and her husband *can* find the extra couple hundred dollars a month. And they will. But it still feels unresolved. 

Jess: I really love, like really trying to understand a problem I’m trying to solve and making sure I’ve like, I feel like that’s the, that’s the hard thing with this is that like every year I’m like, have I thought of everything?

Have I considered all the parameters? Have I I done the right research?

And just kind of feeling like on your own with it, even though, you know, everyone’s going through the same thing.

Dan: For sure. For sure.

Jess: It sucks.

Dan hosting: Here’s what’s coming next: 

We’re gonna come back to Emily’s story– and mine. There’s a POSSIBLE less-sucky option for Emily — it’s gonna take some doing — and in every case: 

We’re looking closely at the options we DO have. Going through all that paperwork is not fun, but the details we found buried there are gonna make a HUGE difference  

We knew where to find them because we’ve been doing this — looking at the puzzle of shopping for health insurance — for a lot of years now. 

We’ll walk you through some of what we did, and recap some of what we’ve learned over all this time.

That’s coming right up.

This episode of An Arm and a Leg is produced in partnership with KFF Health News — that’s a nonprofit newsroom covering health issues in America. These folks are incredible journalists — their work wins all kinds of awards, every year. We are honored to work with them.

Let’s go back to my house for starters. As you may recall, our plan for next year is gonna cost about 500 dollars more every month. That’s 6 thousand dollars for the year.

And Devorah and I were processing.

Devo: I mean… 

Dan: It’s a lot.

Devo: That’s a lot of money. 

Dan: It’s a lot of money. 

Devo: And that’s just like additional money. Like we’re already hemorrhaging money on health insurance, like before it goes up $6,000. 

Dan: Right? Right. We’re already paying a lot. We’re already paying a lot, and so we’re looking at adding $6,000 to that and… 

Devo: Can I have a different timeline?

Dan: Yeah, we’d all like that. Right now there are alternatives. Um, they’re not great. 

Devo: Okay. 

Dan hosting: Our broker had sent us a couple other plans to look at. And they were a little less: Instead of 2600 dollars a month,

Dan: …They take it down to about 2300.

Devo: Okay. 

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

Dan hosting: I mean, look: ?You think I could make a show like this without some serious support for my mental health?

One reason we’re looking at these super-expensive plans is: our therapists accept them. The co-pays to see them for the “less-expensive” plans were much higher — it ate up all the savings. I had a whole little spreadsheet.

And I was hoping Devorah would be like, “Wow, you’re so good at math!” But she was looking at those totals for the full year and doing her own math.

We’ve got a kid who’ll be applying to college next year, and Devorah’s been using a tool called the “net price calculator” — looks at a bunch of factors, and gives an estimate of what we’d probably pay after any financial aid. 

Devorah was mentally comparing what she’d seen there to what my spreadsheet said we’d be paying for health care next year.

Devo: Do you know that this looks exactly like what the net price calculator says we might pay for college in a year? No, I’m serious. 

Dan: I know you’re serious. 

Devo: I’m like writing the net price calculator with our income and it’s coming out with like almost the exact number you’re saying we could pay on healthcare.

Dan: Yes, that’s right. And this is… 

Devo: that’s insane. 

Dan: And this, right. Well, and this is, the big number to look at next is deductible. And that’s where things get very different. 

Dan hosting: Especially because all of these plans — the “cheaper” ones and our current one–had a feature I’d never noticed before: *family* deductibles. A kind of safety valve where if one person’s expenses passes a certain point, insurance kicks in for the whole family. 

On the quote-unquote “cheaper” plans, those family deductibles were five thousand, even ten thousand dollars more.

I mean, I hope we don’t end up in that kind of territory. The deductibles on our current plan are already in the thousands of dollars. But if we ever got there, I’d sure want to stop the bleeding five thousand dollars sooner.

Devo: I kind of am leaning towards 

Dan: Yeah. Keeping what we have. 

Devo: Keeping what we have.

Dan: Right? Yeah. It’s weird because I’m like, wow, but that’s 

Devo: $6,000 more a year. Okay. Okay. I’m gonna go take some deep breaths now. 

Dan: Yeah, 

Devo: I don’t like it. 

Dan: No, me either. Sorry. Thank you for joining me with this. I’m sorry. Super sucks.

Dan hosting: It does — and six thousand dollars is a LOT of money for us. But it turns out, those “alternative” plans don’t save us any money, and they leave us potentially on the hook for thousands and thousands of dollars more.

So I am taking this as a win. And it’s the lesson: If there’s ANY way to look beyond the monthly premium, you gotta do it. 

Read the fine print! If you’ve got ongoing health care stuff — or stuff you’re GONNA do next year, like, I dunno, have a kid? — price it out for any plan you’re considering.

Learn the stupid vocabulary: Deductible. Out of pocket max. This time around, I actually learned a new one: FAMILY deductible.

And then we get back to Emily’s case. Which actually has a happier side to it. Especially after we read some fine print.

Emily, we left you with Elisabeth Benjamin. She had a couple of options for you.

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

Dan hosting: Yeah, because you’d lose the subsidy you have now. But my guy Kurt, my insurance broker, 

Emily hosting: Kurt! 

Dan hosting: He says there’s another way: If I can bring you on at 30 hours a week — versus now you’re at 20 hours — then Blue Cross of Illinois would consider you a full-time employee, eligible for ben efits with An Arm and a Leg. And.. you, know, I’m working on it…

Emily hosting: I know. I know you are.

Dan hosting:  Yeah so, toward that end, Kurt has sent me a couple of plans that you could enroll in. And like even if you had to pay the whole premium, they’re less than these New York plans. One’s like six hundred, the other is about six-ninety.

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

… I’ll put it in the chat.

Emily: Okay

Dan: so the first number is, let’s just look

Emily: Wait I’m putting I gotta put Zoom on, uh, 200% here.

Dan: Yeah, yeah. You for sure. 

Emily: …cuz they’re little. Okay, okay. 

Dan: So. This number really pops out at me, what is the overall deductible? It seems to say $850 deductible. 

Emily: Mm-hmm Mm-hmm .

Dan: Sounds pretty good. Sounds a little like, is that a typo?

Emily hosting: OK- lower premium, lower deductible. What about my copays? Remember – my New York marketplace options have zero dollar copays for insulin and diabetes supplies. 

Dan: This would be one where we would like, have to do a little more digging to figure out what your out OFP pocket would be.Let me see what I can find out. Lemme see what I can… 

Emily: Yeah I mean like the advice that we were giving people like— contact your HR department. It’s like, Dan are you the HR department? 

Dan: I am, I am. So I’m like, yeah, let’s do this. Let me, this is gonna take a 

Emily: Yeah yeah.

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

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

Emily hosting: Yes, the formulary. That’s an insurance company’s list of ALL THE DRUGS they cover–  and what you’d pay for each one. If you’re a First Aid Kit newsletter subscriber, you know we just wrote about them last week. Ok, so we started off looking for my continuous glucose monitor supplies.

At first, it looked like: They were gonna be kind of expensive. $60 a month. But there were little letters off to the side– one was CW, which seemed to stand for “cost waived.” We hit Control-F…

Dan: Okay. So that’s here. It says, uh, cost waived – CW –Medicines marked with a CW in the coverage requirements and limits column are mandated in the state of Illinois to have $0 member cost.

Emily: Hey.

Dan: Yeah, right. Yeah.

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

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

Dan: If you visit a healthcare provider’s office, primary care to treat an injury or illness, deductible does not apply.

Emily: Hell yeah.

Dan: Yeah. Whew. All right. That seems like a good deal.

Emily: Yeah. Yep. Exactly.

Dan: All right, cool. This is excellent. Okay. So I think what we’ve found through our sleuthing, your sleuthing is, yeah, this is a better deal and it’s all in the fine, it’s all in the fine print.

Emily: It is, yeah.

Dan: Yeah. Alright. All right. Well this is good. I feel like we are like, now all you gotta do is raise money to bring you on for the extra hours and you know, but like we’ve done the hard part.

Emily: Yeah, yeah, exactly. Exactly. We’ve deciphered, um, insurance lingo…

Dan: Oh my God.

Emily: …and now we just have to pass a hat around, so.

Dan: Let’s do it. 

Dan hosting: So, OK, we have modeled some stuff for you here:

If there’s medical stuff you know you’re gonna need: Look beyond the monthly premium.

Look at that Summary of Benefits and Coverage. Look for the drug formulary. Read the fine print. Use Control-F. Make calls. 

And we have a ton of resources to help you keep the whole thing straight: We’ve covered this stuff before, in depth, in our First Aid Kit newsletter, and on the podcast — and we’ve collected the most-important, most-useful stuff, and organized it into a Starter Pack on our website.You’ll find a link wherever you’re listening to this.

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

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

There will be people looking to take advantage of this whole crunch: Pitching junk insurance plans and other “bargains” that don’t actually cover enough.

And there will be a lot of people facing bills they just cannot pay. Medical debt — and aggressive debt collections — all of that is gonna hit even more people.

Which, honestly, is why it’s so important for us to keep doing this work. Together. So many people are going to be in so much need in the coming year — years.

Everything we can learn about fighting unfair bills, applying for financial assistance, avoiding ripoffs, and HELPING EACH OTHER. We’ve gotta keep spreading it around.

And to do all of that: We need your support. For example: yes I want Emily to have more hours so she can have insurance, but I need more of her time because we’ve got so much work to do. 

So yeah, we need your help.

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

And if you’re catching this in November, well: Through the end of the month, because of a special matching fund from the Jonathan Logan Family Foundation, those donations are DOUBLE-matched. 

You give us a hundred dollars, and in November, it gets turned into three hundred dollars. 

And lots of you have been taking advantage of this opportunity in the last few weeks. It’s amazing.

And some of you have been adding notes. Kimberly from Texas wrote: “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.”

Kimberly, thank YOU so much.

OK: The place to go is arm and a leg show dot com, slash support.

Arm and a leg show dot com, slash, support.

We’ll have a link wherever you’re listening. Everything you give gets matched. Let’s do this now.

Thank you SO much. Arm and a Leg show dot com, slash, support.

We’ll be back with another episode soon. Till then, take care of yourself.

This episode of An Arm and a Leg was produced by Emily Pisacreta and me, Dan Weissmann, with help from Claire Davenport — and edited by Ellen Weiss. 

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions. 

Claire Davenport is our engagement producer.

Sarah Ballema is our Operations Manager. Bea Bosco is our consulting director of operations. 

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

 Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this show.

An Arm and a Leg is distributed by KUOW, Seattle’s NPR news station.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.

They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

Finally, thank you to everybody who supports this show financially.

You can join in any time at arm and a leg show, dot com, slash: support.

And in fact:  Here are the names of a few people who have pitched in for this year’s NewsMatch campaign.  Thanks this time to…[names]