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The No Surprises Act took effect January 1, 2022. For specific categories of care, it ended a genuinely harmful practice: patients receiving out-of-network bills for emergency care or for out-of-network providers at in-network facilities where they had no ability to choose. KFF data shows the share of privately insured adults reporting unexpected out-of-network bills declined between 2021 and 2023. The law worked in the categories it covered. For one major category, ground am

Many retirees split the year between two states. If you’re one of them and you’re in a Medicare Advantage plan, it’s worth knowing what your plan covers in your second home before you need care there. The answer depends on your plan type, how long you’re away, and whether your plan offers a travel benefit. How Medicare Advantage Coverage Works Geographically Medicare Advantage plans are built around a service area, usually a county or group of counties where the plan has a pr

Direct primary care (DPC) takes insurance out of routine office visits. You pay a flat fee, usually monthly. In return you get your primary care doctor’s office visits, care coordination, and many basic lab and in-office services. AAFP’s 2024 data brief puts typical fees at $50 to $100 a month. Some practices charge more, and family memberships often start around $100. The model works because the doctor sees far fewer patients. AAFP reports the average DPC panel is about 413

Infertility treatment isn’t one of the ACA’s essential health benefits, and no federal law requires plans to cover IVF. Whether you’re covered depends on three things: your state’s law, the type of plan you have, and whether your employer chose to add fertility benefits. Before you start treatment, the answer is often harder to find than it should be. And getting it wrong is expensive. The State Mandate Landscape As of April 2025, RESOLVE: The National Infertility Association

The death of a spouse forces some of the most time-sensitive insurance decisions a person will ever face. They arrive while the survivor is grieving, settling an estate, and running a household alone. COBRA, Medicare, and the marketplace each run on fixed clocks that don’t pause for hard circumstances. Missing one can mean a gap in coverage, or a Medicare penalty that lasts for life. What to Do First Within the first few weeks, four things matter most: Figure out what kind of

The Small Business Health Options Program, or SHOP, was supposed to be one of the ACA’s main tools for getting small employers to offer coverage. It never took off. In 2014, the Congressional Budget Office projected that 4 million people would be covered through SHOP by 2017. When CMS released a national count in 2017, the number was 232,698. Almost half of those were in two places: the District of Columbia, with 64,805 people, and Vermont, with 46,099. The federal SHOP, whic

In 1988, 66% of large employers that offered health benefits also covered their retirees. By 2024, that share was 24%, according to KFF’s annual Employer Health Benefits Survey. Workers who built retirement plans around the idea that an employer would carry them to Medicare have had to recalibrate. For most, that happens in their 50s, when there’s less time left to plan. What Drove the Decline An accounting rule set things in motion. In December 1990, the Financial Accounting

An employee hired in Ohio who relocates to New Mexico while staying on the company’s Ohio-issued group plan is still covered. What that coverage means in practice can look very different from what the benefits summary describes. Which providers are in-network? Which state’s rules apply? What happens when the employee needs a specialist 1,500 miles from headquarters? Remote work created this mismatch at scale, faster than most employer plans were built to handle it. Which Stat

Congress extended Medicare to people with disabilities in 1972 and built in a 24-month waiting period. Repeated reform proposals have tried to end it, but it’s still in place. A person approved for Social Security Disability Insurance doesn’t get Medicare on the day of approval. Medicare starts in the 25th month of SSDI entitlement. How that clock works matters more than most people realize. SSDI has its own five-month waiting period after the disability begins. The first mon

The United States has nearly 3,000 nonprofit community hospitals. In exchange for their tax exemption, worth an estimated $28 billion in 2020 according to KFF, federal law requires each one to run a financial assistance program for patients who can’t afford their bills. The program has to be written down, publicly posted, and actively communicated, and the hospital has to check whether a patient qualifies before taking aggressive collection steps. Nonprofit hospitals provided

About 64 million Americans did some form of freelance work in 2023, according to Upwork’s annual Freelance Forward study. Most of them handle health insurance without the biggest advantage W-2 employees take for granted: an employer paying most of the premium. In 2025, employers covered about 84% of the premium for single coverage and 74% for family coverage on average. For 1099 workers, self-employed individuals, and independent contractors, health insurance is a full-cost e

Catastrophic health insurance plans occupy a narrow but legitimate space in the ACA marketplace. During open enrollment for 2025, only about 54,000 people chose one, out of more than 24 million marketplace enrollees. That may change. For 2026, CMS opened catastrophic plans to more buyers, and a new federal law made them HSA-eligible for the first time. For the right buyer, a catastrophic plan produces the lowest total annual cost of any marketplace option. For most others, a

About 100 million Americans carry some form of medical debt, according to a KFF Health News investigation. The Consumer Financial Protection Bureau found $88 billion in medical bills on consumer credit reports in its 2022 analysis. The number that gets buried in the coverage of those statistics: a significant share of those people had health insurance when the bills were generated. They weren’t uninsured. They were enrolled in a plan that didn’t protect them from the costs th

Being covered by two health insurance plans sounds advantageous until a billing problem surfaces and neither insurer seems to know what the other did. Coordination of benefits, the process determining which plan pays first and how much each covers, is well-established in insurance law but frequently misapplied in practice. Understanding the rules prevents the two most common outcomes: a patient paying out-of-pocket for a bill the secondary plan should have covered, and a prov

Before 2025, Medicare Part D had no true spending ceiling. You could reach the coverage gap, the so-called donut hole, continue paying significant drug costs until hitting a catastrophic threshold, and then pay a percentage of drug costs indefinitely after that. For most Medicare enrollees, it was manageable. For the roughly 1.5 million who were spending more than $2,000 per year on prescriptions, often people on biologics, specialty drugs, or cancer medications, it was an an

Every marketplace enrollee who received an advance premium tax credit gets a Form 1095-A from the exchange in January. Most people pass it straight to a tax preparer without looking at it. That's fine, until the preparer doesn't know there's a 1095-A, files without Form 8962, and the client gets an IRS notice six months later asking why the credit wasn't reconciled. This happens more often than it should. Three Columns, One Reconciliation The 1095-A has three monthly columns

Divorce has a 60-day notification deadline that most people in the middle of one have never heard of. Miss it, and a spouse loses the right to elect COBRA coverage from the other spouse's employer plan. That's not a technicality; it's a hard cut-off with no exception for contested proceedings, complicated negotiations, or the general chaos of separating a household. The COBRA Rules for Divorce Under federal COBRA rules, divorce qualifies as a qualifying event that entitles a

Aging off your parents' health insurance plan? You get 60 days. That's the window after losing coverage to enroll somewhere else, and it doesn't pause because you're moving, starting a new job in three weeks, or just haven't gotten around to it. Miss it, and you're uninsured until the next open enrollment period, which could be months away. The uninsured rate among adults 19 to 25 is higher than any other age group under 65. That statistic has a cause, and the 60-day window i

Health and life insurance comes with its own language. That language directly affects how much you pay, what your plan covers, and what happens when you file a claim. This glossary defines 45 of the most important insurance terms in plain English, with 2026 figures where applicable. Bookmark this page and refer to it whenever you are comparing plans, reviewing a policy, or trying to understand an explanation of benefits. Core Health Insurance Cost Terms • Premium: The monthl

Early retirement is one of the most financially rewarding goals you can achieve, but the health insurance gap between your last employer plan and Medicare at 65 is one of the most underestimated challenges. Health insurance costs for adults in their late 50s and early 60s are among the highest in the individual market. Planning your coverage bridge well in advance can save tens of thousands of dollars and ensure your retirement income is not derailed by unexpected medical cos