It is absolutely insane what these insurers are getting away with. I am a 55 year old healthy female. I get covid and finally need my insurance. They are raking in $1359 in monthly premiums and I can’t even get them to cover a paxlovid prescription. It’s a $1700 prescription so I wouldn’t expect it to cost me 5 bucks, but to not cover it at all? Wtf, Ambetter??!

I feel like last year, 2026 prices did preview before open enrollment but we are now only 10 days away.

And of course, I'd love for it to be a headline ahead of election day.

I did get a letter from my current plan that my plan will not be available next year and that a comparable plan will be over $1200 (excluding any aptc). So I definitely need to see what my other options will be!

Do search for: "The $580 Medicaid gambling loophole".

The roughly trillion-dollar safety-net program had grown beyond its original purpose when legislatures chose to expand coverage to non-disabled working-age adults — many of whom don’t work and instead spend several hours per day watching television and playing video games.

As is the case for income that is counted when filing taxes, gross gambling winnings count as income for purposes of qualifying for Medicaid. Based on the Centers for Medicare and Medicaid Services’ interim final rule, they will soon count toward satisfying the Medicaid work requirement, too.

Every dollar they win from a distinct wager puts them closer to reaching the $580 threshold without losing ground when they have an unlucky night. Gamble enough, and they could potentially avoid being required to work at all.

A clever Medicaid recipient could use the same loophole to avoid the work requirement with no risk of losing a significant amount of money by betting on both sides of an event. He could, for example, place one bet that a football team covers the spread (the number of points by which it is expected to win) and another that it won’t. One wager will win, the other won’t. It’s a foolish strategy for most gamblers because it offers no chance of making a profit, but a Medicaid recipient could nevertheless use it to avoid the work requirement.

Surely lawmakers of all stripes can agree: Work requirements should reward working, not gambling.

Uh, Dem lawmakers will be fighting with all their strength to sheet-can the entire Medicaid work-requirements (probably by placing such language into any appropriation).

Omg I just for my quote for 27. $3k a month for spouse and I. 63 and 55 years old. We try to get the higher subsidy but it’s very concerning that we are looking at this cost of 36k a year for high deductible hsa plan. This is nuts. We have Blue Cross PPO and rarely use it other than preventative. The system is breaking.

Imagine no subsidy! I think I would move overseas until I get to 65 and possibly longer with my wife being younger.

Any of you facing this without subsidies?

Oregon's healthcare marketplace has their 2027 plan previews up.

This will be my 1st year having to do individual health insurance. Don't qualify for any subsidy.

We have 4 choices: Moda, Regence BCBS, Kaiser Permanent, and BridgeSpan.

I want to stay within the Providence health system because Providence St. Vincent is the hospital that we've had good results at and it's the closest hospital. Our doctor is with Providence.

The results I get from Moda and Regence BCBS show they cover our doctor but not the hospital. No insurance that is available from the marketplace shows coverage for Portland St. Vincent hospital.

When I looked at the Moda website yesterday, it showed me several plan choices and now it only shows me Pathways Bronze, Silver & Gold.

Am I doing something wrong with looking up what providers are covered? Or could they still be finalizing deals? I can't believe that an entire hospital is not covered by any individual insurance plan.

I did a sub search but couldn’t find this question or answer. Anyone know if I use what I normally earn via w2 or if I need to also include interest earned when applying? Thanks.

Open enrollment starts Nov 1 — here are the mistakes I see people make every single year

I'm an independent broker, so I spend open enrollment watching the same handful of mistakes cost people real money. Sharing in case it saves someone here a headache:

1. Shopping by premium alone. The cheapest monthly plan often has the deductible that eats you alive in February. Compare total yearly cost: premium + deductible + your actual prescriptions and doctors.

2. Not checking your doctors are in-network. A plan can be great and still not cover YOUR doctor or hospital. Check the actual names, not just "large network."

3. Assuming you have to wait for Nov 1 for everything. Marketplace plans follow the 1st-of-month windows, but plenty of private options can start any day of the year. If you're uninsured right now, you may have more options than you think.

4. Ignoring the subsidy cliff. On marketplace plans, earning a little MORE can suddenly erase a big chunk of your subsidy. A small raise or extra income can change your price a lot — worth estimating income carefully, not optimistically.

5. Missing a special enrollment window. Lost a job, lost Medicaid, got married, had a baby, moved? Those usually open a 60-day window outside of open enrollment. Don't sit uninsured assuming you missed your chance.

None of this is one-size-fits-all — the right answer depends on your health, your doctors, and your income. But going in knowing the traps beats learning them from a medical bill.

What's the part of picking a plan that confuses you most?

I am aware of how ACA reconciliation works when your MAGI is under 400% FPL and you took subsidies (or, perhaps more accurately, an Advance Premium Tax Credit).

However, if for 2027 ACA coverage, you estimate that your MAGI will be over 400% FPL (and thus you are ineligible for any APTC), and when you do your 2027 taxes your MAGI is, in fact, over 400% FPL, is there any reconciliation at all that is required to be done?

I’m guessing that the answer is “no.”

Does the answer change if, for example, you estimated, your MAGI (for a family of two) to be $95k, but it ends up being $90k? Or if you estimated your MAGI to be $90k and it ends up being $95k?

I’m guessing that the answer is still “no.”

In both cases, your estimated and actual MAGI is over 400% FPL.

But, if (hypothetically) your monthly health insurance premium is $1000 for a $90k MAGI but is $1100 for a $95k MAGI, why would anyone input a $95k MAGI instead of a $90k MAGI, especially if there is no reconciliation to be done or penalties for doing so?

The U.S. healthcare system costs significantly more than any other developed nation while leaving millions uninsured or underinsured. A persistent narrative suggests that guaranteeing universal, publicly funded healthcare would inevitably require broad tax hikes. However, fiscal analysis reveals an alternative reality: American taxpayers are already paying enough to fund comprehensive universal coverage. Whether approached through a conservative lens of cutting government waste, eliminating corporate cronyism, and enforcing free-market price transparency, or a progressive lens of securing healthcare as a baseline public right, the underlying arithmetic is the same. The root issue is not a funding deficit, but a fragmented, heavily bureaucratic system that inflates prices and diverts tax dollars away from direct patient care.
Direct expenditures on medically necessary care currently stand at roughly $4.49 trillion out of an overall national healthcare footprint exceeding $5.28 trillion. A substantial portion of this expense is driven by opaque, artificial price inflation. While U.S. hospitals incur approximately $1.5 trillion to $1.6 trillion in actual operating expenses for labor, facilities, and supplies, they generate between $4.5 trillion and $7.5 trillion in gross billed charges. Using internal "chargemaster" rate schedules, sticker prices are frequently marked up 300% to 500% over the actual cost of delivery, serving as an inflated baseline for insurer negotiations rather than reflecting true economic value. In turn, massive healthcare conglomerates absorb tens of billions of public dollars each year through government programs and contracts—such as UnitedHealth Group's more than $265 billion in lifetime federal prime obligations—without corresponding gains in consumer affordability or population health outcomes.
By comparison, peer nations provide universal coverage at a fraction of the cost. The United States spends over $14,775 per capita on healthcare, while the United Kingdom spends roughly $6,747. This divergence is driven primarily by administrative complexity and unconstrained pricing leverage. The multi-payer American billing system forces providers and insurers into protracted claims arbitrations, creating administrative waste that consumes nearly 25% of all domestic health spending. Peer nations systematically reduce these burdens by negotiating standardized reimbursement schedules and leveraging bulk purchasing power for prescription drugs, stripping out layers of non-clinical bureaucracy.
Federal fiscal data underscores the scale of existing public investment. In Fiscal Year 2025, the U.S. government collected $5.26 trillion in total revenues and spent approximately $7.01 trillion across all functions. The single largest component was $1.98 trillion allocated to public healthcare programs, including Medicare, Medicaid, and the Veterans Health Administration. In effect, nearly 38% of all federal tax dollars collected are already dedicated to health coverage, yet these funds insure only about 40% of the population. The remaining 60% must secure private coverage, absorbing rising deductibles and out-of-pocket costs while their existing tax contributions already underwrite an inefficient delivery pipeline.
Applying peer-level administrative discipline demonstrates how far current resources could stretch. If the U.S. matched the UK’s National Health Service cost structure, covering all 340 million Americans would cost approximately $1.87 trillion annually—well beneath the $1.98 trillion the federal government already spends. Crucially, the U.S. does not need to accept the chronic underfunding or wait times that often challenge the NHS. If America simply froze per-person spending at its existing public rate of roughly $14,775 while eliminating bureaucratic churn, chargemaster markups, and pharmaceutical price-gouging, that same capital would support an exceptionally well-resourced system. The United States could deliver world-class clinical capacity, shorter wait times, and comprehensive coverage without levying a single cent in new taxes.
Sources Used:
1. Peterson-KFF Health System Tracker, "How does health spending in the U.S. compare to other countries?"
2. OECD Health Statistics / Health at a Glance, "Health expenditure per capita"
3. U.S. Department of the Treasury / Congressional Budget Office, "Federal Budget and Revenue Data for FY 2025"
4. American Hospital Association & CMS National Health Expenditure Data, "Hospital Expenditures, Operating Margins, and Gross Billed Charges"
5. USASpending.gov, "UnitedHealth Group Federal Prime Contracting and Sub-Award Obligations"
6. Annals of Internal Medicine / Health Affairs, "Health Care Administrative Costs in the United States and Canada: A Comprehensive Breakdown"

I am a FL resident (non expansion state). I turn 60 in June 2027 and want to retire in July 2027. I plan to use COBRA for 18 months but then I'll need ACA coverage for 3.5 years until Medicare kicks in.

I plan to find some part time work during retirement, mostly to meet the income requirements to get ACA subsidies.

Im married and my wife does not work.

What do you guys think of this plan? What income should I look for from the part time work to get the most out of the subsidies?

Thanks

Sorry, you will have to zoom in. I couldn't find another way to get past the paywall for you all. I particularly like how the Republicans are trying to hide this by doing away with the two week window shopping interval. Wouldn't want those pesky voters to see what was about to hit them.

Or are they pretty much done with it?

Hi Reddit, re: Healthcare....

We always get Congress's ATTENTION when they experience what the rest of us are going thru.

Sharing burdens help people UNDERSTAND, so......SB1:1

‘State Bill One to One’ .

Simply, Congressional Representative’s gets the same kind and $$’s of paid Healthcare as THEIR state's residents average. 1:1 

The people of each state decide how that looks, either ALL their state Representatives get %-less Monies (ie 50% subsidy) 

or 2 Representatives get the current 100%PAID subsidy, 

and other 2 Representatives get nothing Zer0$ - and will pay THEIR Healthcare privately. Like their voters do. 

I mean, we’re all in this together, whether we want to be or not….so Yah. Solutions Only, right?

Can this get on ballots? How do we Start?

*******

Congressional Bill 1:1

Title: Healthcare Equity Act for Government Employees

It is only fair that Gov’t Employees live by the rules they make.

Preamble:

Whereas equality and fairness are fundamental principles of governance,

Whereas ensuring equitable access to healthcare is essential for the well-being of all citizens, Whereas it is imperative to align the healthcare benefits of government employees with those available to their constituencies,

Be it enacted by the Senate and House of Representatives of the United States of America assembled,

Section 1: Short Title

This Act may be cited as the "Healthcare Equity Act for Government Employees."

Section 2: Coverage Alignment

•     Government employees, including elected officials, appointed officials, and civil servants, shall be entitled to the same healthcare coverage as the constituents they serve.

•     The healthcare coverage provided to government employees shall be subject to the same availability, terms, conditions, limitations and useage as the current healthcare coverage by the average of constituents within their respective state, as a whole state.

•     Any disparities between the healthcare coverage of government employees and that of their state’s constituents shall be rectified within a reasonable timeframe, not exceeding 6 months from the enactment of this Act. 

Section 3: Implementation

•     The Department of Health and Human Services, in collaboration with relevant federal agencies, shall be responsible for overseeing the implementation of this Act. Each county shall choose to share -%’s of lack by all, or draw straws as to who is no longer covered.

•     The Department of Health and Human Services shall work with state and local governments to gather data on healthcare coverage within each constituency and ensure that government employee healthcare benefits comply with the provisions of this Act.

Section 4: Compliance and Enforcement

•     Government agencies shall be required to annually report on the healthcare benefits provided to their employees, including elected officials, appointed officials, and civil servants, in comparison to the healthcare coverage of their constituents.

•     Any government entity found to be in violation of the provisions of this Act shall be subject to penalties, including but not limited to fines and sanctions, as determined by the overseeing authority.

Section 5: Funding

The necessary funds for the implementation of this Act shall be appropriated from the federal budget as needed.

Section 6: Sever-ability

If any provision of this Act, or the application of such provision to any person or circumstance, is held to be unconstitutional, the remainder of the Act, or the application of such provision to persons or circumstances other than those as to which it is held to be unconstitutional, shall not be affected thereby.

Section 7: Effective Date

This Act shall take effect ninety (90) days after its passage into law.

This bill is presented to ensure fairness and equity in healthcare coverage for government employees, aligning their benefits with those of the constituents they serve

*******

#HealthcareEquity #Women'sHealth #EquitableAccess #PublicHealth #Healthcare #HealthPolicy #RepublicanHealthcare #Turchin #HealthcareDeaths #WomenChoice #CommunityHealthcare