How to Pay Less for Your Prescriptions and Brace for a Health Insurance Shake-Up

30m
Learn how to cut prescription costs and prepare for steep health insurance hikes if ACA tax credits expire.

How can you make prescription drugs more affordable? What can you do if subsidies in the Affordable Care Act expire and health insurance costs spike? Hosts Sean Pyles and Elizabeth Ayoola discuss rising prescription costs and looming changes to health insurance premiums to help you find ways to save and protect your budget. Joined by Dan Weissmann, host of the podcast An Arm and a Leg, they begin with a discussion of the structural problems in the U.S. prescription drug system, with tips on comparing prices across pharmacies, using discount programs like GoodRx, and checking for manufacturer coupons.

Then, personal finance Nerd Kate Ashford joins Sean and Elizabeth to discuss how ACA premium tax credit changes could impact your wallet. They explore strategies such as comparing marketplace plans carefully, shifting to different tiers of coverage, considering employer-based insurance, and preparing for open enrollment. They also highlight the risks of going uninsured, ways to use preventive care benefits to save money, and why America’s healthcare system ended up so tied to employment.

Want us to review your budget? Fill out this form — completely anonymously if you want — and we might feature your budget in a future segment! https://docs.google.com/forms/d/e/1FAIpQLScK53yAufsc4v5UpghhVfxtk2MoyooHzlSIRBnRxUPl3hKBig/viewform?usp=header

In their conversation, the Nerds discuss: prescription drug costs, how to save on prescriptions, GoodRx, Mark Cuban Cost Plus Drugs, pharmacy benefit managers, drug manufacturer coupons, ACA subsidies, ACA premium tax credits, Affordable Care Act healthcare costs, ACA marketplace plans, health insurance open enrollment, formulary, health insurance tiers, high deductible health plan, bronze vs silver plan ACA, health savings account, ACA premium increases, ACA subsidies expiring, ACA tax credits 2025, how to compare health insurance plans, employer sponsored health insurance, self-employed health insurance options, preventive care coverage, avoiding medical debt, risks of going uninsured, Vermont ACA costs, ACA premium increase by state, ACA cost saving strategies, how to check if prescriptions are covered, negotiating prescription costs, medical bankruptcy risk, Medicare and Medicaid differences, US vs UK healthcare costs, ACA income thresholds, ACA marketplace eligibility, losing ACA subsidies impact, choosing an ACA plan, and ACA open enrollment dates.

To send the Nerds your money questions, call or text the Nerd hotline at 901-730-6373 or email podcast@nerdwallet.com.

Like what you hear? Please leave us a review and tell a friend.
Learn more about your ad choices. Visit megaphone.fm/adchoices

Press play and read along

Runtime: 30m

Transcript

Speaker 2 Next up is a little song from CarMax about selling a car your way.

Speaker 3 Wanna take a sec to think about it. Or like a month.
Wanna keep tabs on that instant offer. With OfferWatch.
Wanna have CarMax pick it up from your driveway.

Speaker 2 So, wanna drive? CarMax.

Speaker 4 Pickup not available everywhere. Restrictions and fee may apply.
apply.

Speaker 2 The holidays mean more travel, more shopping, more time online, and more personal info in more places that could expose you more to identity theft.

Speaker 4 But LifeLock monitors millions of data points per second. If your identity is stolen, our U.S.-based restoration specialists will fix it guaranteed or your money back.

Speaker 4 Don't face drained accounts, fraudulent loans, or financial losses alone.

Speaker 2 Get more holiday fun and less holiday worry with LifeLock.

Speaker 4 Save up to 40% your first year.

Speaker 1 Visit lifelock.com/slash podcast.

Speaker 2 Terms apply.

Speaker 5 Have you ever gone to pick up a prescription and found it cost much more than you were expecting, or your insurance suddenly decided to stop paying for your medicine?

Speaker 6 The former has happened, Sean, and unfortunately, I had to pay for it because I still needed the prescription. So, what's a girl to do?

Speaker 5 Yeah, what a bind. Well, I know a lot of folks have found themselves in the same exact situation.
So, this episode will have some tips for how people can make prescriptions a little more manageable.

Speaker 5 Welcome to NerdWallet's Smart Money Podcast, where you send us your money questions and we answer them with the help of our genius nerds. I'm Sean Piles.

Speaker 6 And I'm Elizabeth Ayola.

Speaker 6 This episode, we answer a listener's question about how to manage healthcare expenses if healthcare tax credits expire later this year, which is expected to make Affordable Care Act plans 75% more expensive on average.

Speaker 5 But first, we're going to dive deep into another aspect of healthcare, prescription drugs.

Speaker 5 I don't know about you, Elizabeth, but paying for prescriptions can sometimes feel like a weird hybrid game of hide and seek and whack-a-mole.

Speaker 5 Like it's hard to find the best price for your prescription. And then once you have it settled, your insurance suddenly decides to change the pricing or drop covers for the drug entirely.

Speaker 6 This sounds like a nightmare. I mean, luckily, I don't have prescription drugs often, but the few times I have, I've been shocked at the cost of them.

Speaker 6 Now, as a girl coming from London where we had universal health care, I still marvel at how much I pay out of pocket for prescriptions and how much work can go into finding a cost-effective option.

Speaker 5 Well, this episode, we're joined by Dan Weissman, host of the NPR podcast, An Arm and a Leg, which helps listeners navigate the truly dysfunctional and absolutely maddening world of healthcare in the United States.

Speaker 5 Dan's going to help us figure out how to make these often vital prescriptions a little more affordable.

Speaker 7 Dan, welcome to Smart Money. Thanks for having me.

Speaker 5 So you did a really helpful two-part series just about how people can navigate the cost of prescription drugs.

Speaker 5 And even though you said folks don't need to take notes because you have a really helpful newsletter, I was taking notes while listening to your podcast.

Speaker 5 But before we get into your tips that I think are just super helpful for everyone, I'd love if we could just zoom out a little bit and hear from you why prescription drugs are just so expensive in the United States.

Speaker 5 I mean, we are paying a lot more for the same drugs than folks in other countries.

Speaker 7 Prescription drugs are part of our whole healthcare system, obviously, which is unlike the healthcare systems of other developed countries.

Speaker 7 More than any other place, we're just like, let the market figure things out. And we'll, and the government will do a little regulation and supplement with things like Medicare and Medicaid.

Speaker 7 But the market will do its thing is a kind of basic idea. And when I started making an arm and a leg, I was like, yeah, what's the deal with the cost of healthcare?

Speaker 7 This is like a whole subgenre of the show, planet money. Like why

Speaker 7 market failures? Like what happens when markets don't actually solve problems except for like shareholders? So here we are. There's kind of two big sets of players in the world of prescription drugs.

Speaker 7 And one of them we know well, the makers of pharmaceuticals who can charge whatever price they want because it's a free country in that or a free market country in that respect.

Speaker 7 And the other is a set of players that most of us don't know about called pharmacy benefit managers. And these are entities that essentially subcontract or used to subcontract to insurance companies.

Speaker 7 Many of them are now essentially owned by or own insurance companies like Cigna and Aetna and others and United Health Group.

Speaker 7 All the three of them own or are owned by the three biggest pharmacy benefit managers.

Speaker 7 So just to let you know, that's a big piece of the puzzle is we have this, not only do we have a big corporate healthcare system, it's consolidated more and more.

Speaker 7 So those guys, their job is to say like, oh, our insurance plan obviously has to cover prescription drugs. Which ones will we pay for?

Speaker 7 How much will our people that we cover pay for this drug versus that drug? This ADHD drug versus that ADHD drug? This blood pressure drug versus that blood pressure drug.

Speaker 7 We could go on a very long time about this, but essentially the pharmacy benefit managers have the job of getting the best deal for themselves and the insurer, but not necessarily making sure that you get the medicine that you need at a price you can afford.

Speaker 7 They make more money other ways. So we are caught essentially between the rock of the pharma companies who are beholden to their shareholders.

Speaker 7 and the hard place of the pharmacy benefit managers who are beholden to the shareholders of the giant companies that they're parts of.

Speaker 5 The system is not designed to give us the care we need at a cost that we can afford.

Speaker 7 It's designed to create profits and it does that really, really well.

Speaker 6 So you made a good point, Dan, which is that these systems aren't necessarily caring about how much it's going to cost the consumer out of pocket to pay for these drugs.

Speaker 6 Can you outline some of the common challenges people face when trying to get prescription drugs?

Speaker 6 Is it that their insurance denies their coverage or that even with insurance, the drugs are too expensive? Or is it both?

Speaker 7 It's both. It's all of the above.
And things can seem so backwards that if you're taking what your pharmacy benefit manager considers to be the wrong drug, the price to you can be super enormous.

Speaker 7 And there may be places you could get that same drug outside of using your insurance for a lot less.

Speaker 6 So then how would someone be able to determine which one is the best route then? What kind of research do they need to do?

Speaker 7 Oh boy. Yeah.

Speaker 7 So we at the beginning of this year asked our listeners and a bunch of experts and a bunch of our listeners are experts, like, what have you done when you've gotten this kind of sticker shock at the pharmacy counter?

Speaker 7 And people told us all kinds of things, and it was super interesting. It's a dizzying array of strategies.

Speaker 7 And I think the thing that I came away from it most, maybe I can tell you some of the details that we got, but is that you start with the things that are the kind of easiest.

Speaker 7 It's kind of like when your doctor is like, well, have you tried taking some Advil or have you tried turning your computer off and turning it back on again? And this list by itself is a bit of a pain.

Speaker 7 But the kind of quote unquote easy things are like, you show up,

Speaker 7 the pharmacist is like, that's going to be $500.

Speaker 7 And this is your chance to ask, hey, could you run my insurance one more time just to see if it's up to date? That happened to me once. It was super interesting.
It went from $400 to $5.

Speaker 6 Shut the front door.

Speaker 8 Yeah, man.

Speaker 7 It was January and the Walgreens just hadn't taken to my new insurance yet. And they were like, our price, based on what we do with this old blind prescription drug, is cash, $400.

Speaker 7 And what I found from looking at coupons online from sites like GoodRX was that I could have gone a couple miles down the road to another place with no insurance and paid $20 for the same.

Speaker 3 Wow.

Speaker 7 So that's a next step is like, have you got my insurance right? Like, and let me check my phone for a second.

Speaker 7 GoodRX is one of a number of sites, and each of them has different deals that will tell you if you kind of scan a barcode from our site at your pharmacy.

Speaker 7 at the pharmacy you're at it's going to cost you x at the pharmacy down the road it could cost you y

Speaker 5 using good rx i found to be really helpful but it always underlines how much of a sham the system is, where if I just drive half a mile down the road to a Walgreens versus the CVS that I'm currently at, I can't save a lot of money on what is the same exact drug.

Speaker 5 And I'm always wondering, why is that the case? Why do these companies, GoodRX and the other ones, work in this way? Are they selling my marketing data? What's the catch?

Speaker 7 Yeah, it's super interesting. Basically, Each one of them is negotiating behind the scenes with different pharmacy benefit managers.

Speaker 7 And they're saying, oh, you have this array where like on the back end, it's super complicated, but like money moves around.

Speaker 7 And when Dan pays $5 at the counter for this medicine, like you get $2 out of that. And, you know, you can kick us a nickel.
It's fine. Right.
That's how that works for them.

Speaker 7 And they're doing all that stuff on the back end. So eat GoodRX is one.
There's several others worth looking up. We have notes on our website.
But like, yeah, look it up.

Speaker 7 Like, can I get a better deal someplace else? Another question you can ask the pharmacist right then. You can ask the pharmacist right then.

Speaker 7 and there is like, hey, is there like a manufacturer's coupon for this thing?

Speaker 7 Often there is for brand name drugs. Often, and you know, what's in it for them?

Speaker 7 The brand name drug company wants to give you a coupon to make up your share of the kind of copay or whatever, because eventually they figure your insurance will kick in.

Speaker 7 And then finally, the other question you ask the pharmacist is like, hey, is there some other version of this kind of drug that my insurance will cover?

Speaker 6 Daniel, in your two-part series, you mentioned how your mileage may vary. So how can people determine which options might give them the best mileage?

Speaker 7 Trial and error. So this is why I'm like, okay, you got, get your list of the quote-unquote easy things first.
Do the easy things. And you can do these things pretty quickly.

Speaker 7 You can run down this part of the checklist in a few minutes if you have it handy. Hey, pharmacist, is there a coupon for this thing? Hey, pharmacist.

Speaker 7 My this asthma medication that I've been taking is supposed to cost me $500 now. Does my insurance cover some other inhaler that works just as good that I could use? I mean, this is all right here.

Speaker 7 Like

Speaker 7 let me look at my phone for a second and see if I can go to CVS down the road and get this for less.

Speaker 7 And then like, those are all things you can do pretty quickly. There are other websites like Mark Cuban's Cost Plus Drugs, which is a mail order site for many generic drugs.

Speaker 7 will give you a super good deal. You're going to pay five bucks for shipping.

Speaker 7 So it kind of works best, I think, for people who take multiple generic drugs and whose insurance is kind of like not making that easy for them.

Speaker 7 But for if that's your situation, that could be great for you. One listener that we talked to, you know, had to go farther, right?

Speaker 7 His daughter's medicine, the insurance company was like, the best we can do for you, it's like 150 bucks. And that was a lot.

Speaker 7 And he was like, can I get a better deal by using one of these GoodRX type sites or Mark Cuban's Cost Plus? And he built a spreadsheet. He was like, okay, I'm going to look at all of them.

Speaker 7 I'm going to see what the best deal is where. And like, we adapted and expanded that spreadsheet.
You can do that. That's obviously more homework.

Speaker 7 But the easy parts that you can do at the pharmacy, and then there's like, okay, I got to go and crank on this. So one is like, all right, my insurance isn't doing it for me.

Speaker 7 I'm going to make a spreadsheet. I'm going to figure this out.
What's my best deal? The next level is, or another level at the same time, is like, all right, my insurance said no to this.

Speaker 7 As one listener said, like,

Speaker 7 you should do like, I'm going to take that as a suggestion, right? It's not an answer. That's a suggestion.
They're saying no. I'm like, okay, well, let's, let's talk about that.

Speaker 7 I mean, they will have their rationale. This is where you get your provider involved.
And, you know, this is a problem for a lot of us. Like, my primary care doc love the guy.

Speaker 7 It's a bit of work to get him on the phone, right? This is a problem a lot of us have. But so you're going to look for somebody who can do that for you.

Speaker 7 And especially if you're taking the drug with a specialist, like you can can get this help from them and be like, let's do an appeal. And there are rounds of appeals you can do.

Speaker 7 All these things take time, right? Like you're like, hey, my physician's fighting for an appeal. But meanwhile, I need this medicine now.
Like I can't breathe without this inhaler.

Speaker 7 This is where you ask your provider a second question. Did you get any free samples from the pharma company that tied me over while we're doing this? Right.

Speaker 7 This was a suggestion that came from a listener who's a pharma rep. So, you know, that's his job.

Speaker 5 Because they may well have the inhaler in the office and they can just give you one until you can sort through all of the issues with your insurance.

Speaker 7 Yes. And it's not going to be necessarily a permanent solution.
I mean, they may be like, I got these, I got a closet of these, Dan, come back every week. It's totally fine.

Speaker 7 They may, or they may be like, I hate pharma reps or our whole system does not allow pharma reps in the complex that we operate. Apparently, they could still go online.

Speaker 7 for you and say, could somebody please drop off these samples for Dan?

Speaker 7 But the idea here is is not that this is a kind of permanent supply for you, but that it's while you're fighting with your insurance to get them to come around and be like, okay,

Speaker 7 we will cover this for you because this is the drug you need. We thought you could take that other asthma medication.
You and your doctor have convinced us that that one has a specific risk for you.

Speaker 7 You need this one.

Speaker 5 So basically at every step of the process, you need to be not taking no for an answer and finding some sort of other alternative route.

Speaker 5 So Dan, looking ahead, open enrollment is going to be here pretty soon. What should folks do now so they can ensure that their prescriptions are actually covered by their insurance next year?

Speaker 7 This is such an important question.

Speaker 7 So there is a document that you are legally entitled to see from whatever your insurance is or any insurance plan that you're considering for next year. It's called the formulary.

Speaker 7 And it's going to be a long PDF. And you may have to ask somebody where you find it, but you're entitled to have it.

Speaker 7 It is the list that says if you're taking this drug, it's going to cost you this much. If If you take that drug, it's going to cost you that much.
And these things can be confusing.

Speaker 7 And last year, I spent several, I spent a morning trying to figure out why I'd gone to one pharmacy and paid $35 for this drug.

Speaker 7 And the next month, I'd gone to a slightly different pharmacy and paid $75 for it. And I eventually figured it out.
That was some advanced stuff. But generally, you can see it.
Like

Speaker 7 they're broken into classes. Like these are the statins.
These are the blood pressure drugs. These are the antidepressants.
And they list every single one.

Speaker 7 And generally, the formulary will say rather than have a dollar amount, it'll have what are called tiers. So like tier one drugs, you pay $5 for, tier two drugs, you pay $20 for.

Speaker 7 Tier three drugs, you pay $50 for. Tier four drugs, you pay 20% of whatever.
And again, those numbers are going to be different for every insurance plan, but they all have tiers.

Speaker 7 And you will find your drug. You'll do a control F, hit find on that PDF, and find the name of the medicine that you need or the class of medicine that you need.
And it'll tell you.

Speaker 7 And that, if you are lucky enough to be able to choose an insurance policy and that formula tells you, hey, man, next year your inhaler is going to be 500 bucks. You can be like, okay, cool.

Speaker 7 Let me just check if there's another policy I have access to. If there's a, if they will let me have that inhaler for less.
Or

Speaker 7 if this, if the formula for this one is like, but you could have this other inhaler for 20 bucks, do it now, right? Call your doctor and be like, hey, doc, would this other inhaler work for me?

Speaker 5 Another time we have to do a lot of homework to get what you would hope would be basic and just given from your insurance. Well, Dan, thank you so much for coming on and sharing your insights with us.

Speaker 5 I'm really going to encourage our listeners to check out that two-part series that you guys put out. I found it, again, extremely helpful.
Thank you so much.

Speaker 6 All right. We're about to get into this episode's Money Question, where we talk about what folks need to know about potential changes to the cost of their Affordable Care Act plans.

Speaker 5 But before we move on, a quick reminder to send us your money questions. We're at a transitional moment in the year where summer is beginning to wind down.
We're looking forward to fall.

Speaker 5 At least I know I am. I really want to wear a sweater and stop sweating.

Speaker 5 And with this new time of year comes a new batch of financial decisions, like how should I navigate tariffs this holiday shopping season?

Speaker 5 How should I change my health care plan to I'm eligible for an HSA? And when is the best time to buy tickets for holiday travel? Elizabeth, do you have any money questions at the moment?

Speaker 6 Well, this is kind of random, but I do. I'm wondering how to negotiate the best rental agreement because I'm tired of paying to cut my grass.

Speaker 6 Yeah. I've also been thinking about how to ensure your emergency fund keeps pace with inflation.

Speaker 5 Well, we know those high-end savings accounts we always talk about are a good place to start.

Speaker 6 Absolutely.

Speaker 5 Well, folks, whatever your money question, we nerds are here to help. Leave us a voicemail or text us on the nerd hotline at 901-730-6373.
That's 901-730-NERD or email us at podcast at nerdwallet.com.

Speaker 6 All right, let's get to this episode's money question segment. That's up next.
Stay with us.

Speaker 1 Today's episode is sponsored by ADT.

Speaker 6 You're ready for the holidays.

Speaker 1 The turkey's been going since this morning.

Speaker 6 The sides are perfectly seasoned.

Speaker 1 The out-of-towners have a bed, couch, or futon to crash on for the night.

Speaker 6 All that's left to take care of is your peace of mind. And that's why ADT is here.

Speaker 1 With their professionally installed home security systems, you get protection that helps you feel safe.

Speaker 6 So you can focus on that pie that you forgot to bake.

Speaker 1 When every second counts, count on ADT.

Speaker 6 Visit ADT.com or call 1-800-ADTASAP to find out more.

Speaker 8 Hiring isn't just about finding someone willing to take the job. You need the right person with the right background who can move your business forward.

Speaker 8 If you want candidates who truly match what you're looking for, trust Indeed Sponsored Jobs. With Indeed Sponsored Jobs, your post stands out to quality candidates who who actually fit the role.

Speaker 8 According to Indeed data, 90% are more likely to be hired and trusted by 1.6 million companies. Spend more time interviewing candidates who check all your boxes.
Less stress, less time, more results.

Speaker 8 Now, with Indeed Sponsored Jobs. And listeners of this show will get a $75 sponsored job credit to help your job get the premium status it deserves at Indeed.com slash podcast13.

Speaker 8 Just go to Indeed.com slash podcast13 right now and support our show by saying you heard about Indeed on this podcast. Indeed.com slash podcast13.
Terms and conditions apply.

Speaker 8 Hiring, do it the right way with Indeed.

Speaker 6 We're back and we're answering your money questions to help you make smarter financial decisions. This episode's question comes from an email from a listener named Rebecca who lives in Vermont.

Speaker 6 Here it is and it's going to be read by our fabulous producer Tess Wiglund.

Speaker 9 I have to tell you you guys, the first line is my favorite from any email we've ever gotten.

Speaker 7 I love your show.

Speaker 9 Thanks for the work you do.

Speaker 7 You are so welcome Rebecca.

Speaker 9 All right here's the question. I'm aware that the enhanced tax credits for ACA insurance plans are set to expire at the end of 2025.
I currently work two part-time jobs.

Speaker 9 One is a W-2 job in the education field, and I have access to good insurance through that job. The other is a self-employment job where I work as a contractor.

Speaker 9 After a long career in education, I assumed my current part-time role would be my last before an exit from the field and that I might have a year or maybe two left before I pursue my self-employment full-time.

Speaker 9 But the outlook for health insurance costs is, frankly, freaking me out. I live in Vermont where ACA healthcare premium rates are some of the highest in the country.

Speaker 9 If the subsidies expire, I could probably still afford it. But many other things would have to be cut or scaled way back, such as saving for retirement.
Here are my questions.

Speaker 9 One, what's the outlook for these ACA subsidies going into 2026 and into the future? Two, what are some potential strategies to reduce the cost of health insurance if you have to buy it for yourself?

Speaker 9 Three, should I seek out a job that might pay less than my self-employed contracting, but offer me decent insurance? And four, what are the risks of going uninsured?

Speaker 9 I'm healthy and could afford to pay for preventive care out of pocket, but I worry that a disaster will happen like cancer and bankrupt me if I go uninsured.

Speaker 9 I hate that we tie affordable insurance to employment in the U.S. Thanks for your help, Rebecca.

Speaker 5 To help us answer Rebecca's many questions, on this episode of the podcast, we're joined by personal finance nerd Kate Ashford. Kate, welcome back to Smart Money.

Speaker 5 We seem to always have you for some of the heaviest and most difficult topics. So here we go.

Speaker 7 Let's do it.

Speaker 5 Sure. So let's start by diving into the enhanced premium tax credits that the listener referred to.
Can you explain how these work under the ACA?

Speaker 10 Absolutely. So if you are buying health insurance for yourself on the marketplace, there are subsidies available to help you pay for it, depending on your income.

Speaker 10 These are tax credits you either claim at the end of the year or that are credited in advance to lower the cost of your premiums.

Speaker 10 And right now, there are bigger subsidies in place and expanded eligibility because of legislation that was put in place in 2021.

Speaker 10 There are more than 24 million people enrolled in marketplace plans right now, and the vast majority of them are getting subsidies.

Speaker 6 These These enhanced tax credits are going to sunset at the end of 2025, and that means we go back to the smaller, more limited tax subsidies from before.

Speaker 6 So, Kate, what impact could that have on people going through the ACA for their health care plans?

Speaker 10 Well, it's hard to understate the effect that this would have. For people getting subsidies, and remember, that's most people buying from the marketplace.
Premiums are expected to go up. dramatically.

Speaker 10 And the Congressional Budget Office predicts that more than 4 million people will lose insurance by 2034.

Speaker 6 And then, what types of increases could consumers see in health care costs, especially premiums?

Speaker 10 Well, KFF, which is a health policy nonprofit, is predicting that premium payments will go up by more than 75% on average.

Speaker 10 And in some states, people are going to see their payments more than double, so a lot. The Commonwealth Fund also has some estimates on this.

Speaker 10 And depending on where people fall on the income scale, they could pay anywhere from $387 more to $2,900 more per year. And that's just the average.

Speaker 10 And that's just the cost effect of losing enhanced subsidies. But insurance companies are also requesting higher base premiums next year.

Speaker 10 So it's also that the base price of health insurance is going to go up.

Speaker 10 And that's because, among other things, companies predict that if enhanced subsidies aren't extended, healthy people are going to drop their coverage because it's going to be expensive.

Speaker 10 And that leaves mostly sick people in the system. And that makes costs go up for everybody.

Speaker 5 So these changes could really upend people's budgets if they end up needing to pay, you know, 75% more for their health insurance.

Speaker 5 It's going to be pretty devastating to people's household incomes, I'd imagine.

Speaker 10 For sure. Big, big impact.

Speaker 5 So what can folks do now to prepare for these potential changes? A lot of folks are probably eyeing open enrollment coming up in just a few short months and thinking now is the time to plan.

Speaker 10 Exactly. For states using the federal marketplace, open enrollment starts November 1st and people have to sign up by December 15th for coverage to start next year.

Speaker 10 So that's going to be here before you know it. If you've got subsidized health insurance through the ACA marketplace, the first step is to see how you might be affected if these subsidies expire.

Speaker 10 The big question is if you're making more than four times the federal poverty level, because if you are, you could go from subsidies to full price next year.

Speaker 10 But subsidies are going to get smaller even for people who are under that line.

Speaker 10 So you may want to do some back of the napkin math to see what your premiums would look like if they went up 75%, which is the expected average increase. Or on November 1, you can price it out.

Speaker 10 And can you afford that? If you were on the line for subsidies, no subsidies, can you put more money into a retirement account or a health savings account to get your income under that line?

Speaker 10 And if you can't move income around and your costs are going to go up so much that you really can't afford it, you may want to think about whether formal employment offering benefits makes more sense.

Speaker 10 for your health insurance needs.

Speaker 5 People are going to have some really tough decisions to make. Yes.

Speaker 5 So for people who buy their own health insurance, what are some general cost-saving strategies that can help them make this a little more manageable given how expensive it all is?

Speaker 10 Yeah, there are some ways to save on costs, but they're not all super. You can move from a silver plan to a bronze plan on the marketplace, although your out-of-pocket costs for care will be higher.

Speaker 10 You can opt for a high-deductible health plan, which typically has lower monthly premiums, but you have to be prepared to cover the deductible if you need care beyond preventive care.

Speaker 10 And that deductible will be several thousand dollars. dollars.
Definitely shop extensively. Definitely compare plans, compare pricing.

Speaker 10 Make sure you're looking at plans that include your doctors and hospitals so you can stay in network. If you're self-employed, your health insurance premiums may be a deductible expense.

Speaker 10 So that's something to keep in mind. Although, as always, you know, check with the tax professional.

Speaker 10 For prescription drugs, you can look into programs like GoodRX or Single Care or manufacturer discount programs that may be available. And this bears saying, use your preventive care benefits.

Speaker 10 ACA compliant plans are required to cover most preventive services at no cost, and it can help you catch health issues before they get out of hand.

Speaker 5 And that would be things like an annual checkup, a physical.

Speaker 7 Absolutely, yes. Okay.

Speaker 5 So how can people weigh whether it's more cost-effective to get employer-sponsored health care or buy it on their own via the health insurance marketplaces or other avenues?

Speaker 5 I'm sure, like the listener, many self-employed people may be wondering whether it's cheaper to go the employer-sponsored route so they could potentially get more affordable coverage.

Speaker 10 Unfortunately, if enhanced subsidies go away, employer-sponsored health insurance is likely going to be cheaper because employers cover some percentage of your premiums.

Speaker 10 I think if subsidies disappear, a lot of people are going to be looking for jobs or hanging on to jobs if they were planning to leave them that offer these benefits instead of continuing on their own or they're going to drop coverage.

Speaker 6 This potential new change could make health care unaffordable for some Americans and it could lead to them going uninsured as the listener is considering.

Speaker 6 So what are some risks of going without insurance?

Speaker 10 Well, so clearly you're risking getting really sick and having to pay for care out of pocket. Suppose you take this bet and as the listener mentioned, you develop cancer or you have a heart attack.

Speaker 10 The medical bills are going to be significant. And other things to consider are the consequences of medical debt, like a lower credit score and just general financial stress.

Speaker 10 People without health insurance are more likely to delay preventive care and screenings, which means you might not catch something until it's more serious.

Speaker 6 If the listener is anything like me, thankfully for now, I have been healthy and not had any serious health conditions.

Speaker 6 So, you know, do healthy people have the same risk as maybe people with existing health conditions?

Speaker 10 It's riskier to go without health insurance if you have a chronic illness, of course. But it's a gamble for healthy people too.

Speaker 10 No one plans to have a serious accident or develop a sudden illness, but it can happen at any time. to anyone, regardless of how healthy you are now.

Speaker 10 And the financial consequences can be catastrophic. Medical issues, including medical debt, are one of the biggest causes of personal bankruptcy in the U.S.

Speaker 5 So our listener ended their question by saying that they hate that we tie healthcare to employment in the U.S. Kate, I'm wondering if you have any insight into the history here.

Speaker 5 Why and how did we get to this place?

Speaker 10 Well, I've done a little research on this, and this is just the way the system evolved in the U.S. During World War II, the government put wage freezes in place.
to control inflation.

Speaker 10 So employers started offering health insurance as a French benefit instead, since they couldn't offer higher salaries. And in 1943, the IRS made employer-provided health insurance tax exempt.

Speaker 10 So that was a big incentive. After the war, we just continued down this path and insurance from your employer became the primary method of coverage.
The U.S.

Speaker 10 has talked about a universal or single-payer healthcare model since then, but we've never made it happen.

Speaker 5 So what I'm hearing is that our current situation is somewhere between a mistake and a horribly unhappy accident.

Speaker 10 I think that sums it up, yes.

Speaker 7 Okay.

Speaker 5 Well, do you have anything else to to add, Kate?

Speaker 10 Yeah, only to say that even with all of this information, this is all up in the air.

Speaker 10 There's still time for Congress to put something together and extend these subsidies, and we'll all be waiting to see how that goes. So pay attention to the news because this could all change.

Speaker 5 And we may well drag you back on to talk about it again.

Speaker 7 Happy to come back.

Speaker 5 Thanks, Kate.

Speaker 10 Sure, absolutely.

Speaker 5 That's all we have for this episode. Remember, listener, that we are here to answer your money questions.
So turn to the nerds and call or text us your questions at 901-730-6373. That's 901-730-NERD.

Speaker 5 You can also email us at podcast at nerdwallet.com. Don't forget, we want to help you with your budget.

Speaker 5 Visit the link in the episode description to fill out the Google form with your budget info, and we might talk about it with you on a future episode.

Speaker 5 Join us next time to hear the first episode of this new budget rehab series, where we take a deep dive into a listener's budget and look for ways to improve it.

Speaker 5 Follow Smart Money on your favorite podcast app, including Spotify, Apple Podcasts, and iHeartRadio to automatically download new episodes.

Speaker 6 And here's our brief disclaimer: We are not your financial or investment advisors.

Speaker 6 This nerdy information is provided for general, educational, and entertainment purposes, and it may not apply to your specific circumstances.

Speaker 6 This episode was produced by Tess Viglund and Anna Helhoski. Hilary Georgie helps with editing.
Nick Charissimy makes our audio.

Speaker 6 And a huge thank you to NerdWallet's editors for all of the wonderful ways they help us.

Speaker 5 And with that said, until next time, turn to the nerds.