[S1E9] Vincent Catalano: Navigating Rising Premiums, Subsidy Loss, and Smart Strategies for 2026

What to Do When Your Health Insurance Costs Are Skyrocketing

Vincent Catalano tackles the anxiety-inducing reality of rising health insurance premiums as ACA subsidies face elimination, explaining what individuals and families need to know to make smart coverage decisions for 2026.

Vincent addresses the widespread panic as people receiving plans from ACA exchanges worry about losing subsidies that kept their premiums affordable. With subsidies disappearing, lower-income individuals are facing multi-thousand-dollar annual bills they weren't previously paying, creating a crisis that has everyone freaking out—not just consumers, but insurance companies and hospitals too.

The episode focuses on a concept most people overlook: the annual maximum out-of-pocket. Vincent explains that this is the magic number where insurance pays 100% of costs for the remainder of the year—typically around $7,000 for individuals and $14,000 for families. Understanding this number is crucial for evaluating whether to buy insurance at all and which plan level makes financial sense.

Vincent walks through the real math of insurance decisions. For example, a family bronze plan costing $2,000 monthly represents $24,000 annually. Add the $14,000 maximum out-of-pocket, and you're looking at a worst-case scenario of $38,000. He discusses the temptation to go uninsured and adopt a cash-pay strategy, warning that while emergency rooms must treat you regardless of insurance status, this approach has serious limitations for chronic illnesses and long-term care. Unpaid medical bills can lead to asset seizure if you own a home, car, or have bank accounts.

The conversation shifts to plan selection strategy. Vincent challenges the assumption that gold and platinum plans are always better, noting that many bronze, silver, and gold plans have identical annual maximum out-of-pockets. The only difference is that you pay more premium on higher-tier plans to reach that maximum slower—essentially throwing money away if you're relatively healthy.

For prescription drugs, Vincent strongly advocates for Mark Cuban's Cost Plus Drug Company for generics and GoodRx for price comparison across local pharmacies. He shares that he often pays less through Mark Cuban's platform than through his own high-deductible health plan, demonstrating how dramatic pharmacy price variations can be.

The episode concludes with a pragmatic message: buy the lowest-cost insurance you can afford, be strategic about drug shopping, and maintain the perspective that this situation will eventually work its way through the political system—though probably not in time for 2026 coverage decisions.

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Transcript

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Welcome to the Clearly Beneficial podcast,

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the show where we rip off the Band-Aid and explore the future of healthcare,

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benefits,

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and the people driving innovation in the industry.

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To learn more how they can help you, visit healthnext.com.

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So nothing like sitting in a doctor's office waiting for a little

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skin cancer removal, to talk about healthcare.

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And so I think everybody's a little freaked out,

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especially if they are receiving their plans from ACA marketplaces,

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worrying about the loss of their subsidies.

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And that will create anxiety because premiums are going up

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insanely high, especially if you were in a lower income bracket.

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And now you're looking at a multi hundred dollar bill when you were not looking at

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that before,

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or even a family of four looking to pay for insurance.

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And now all of a sudden you're realizing that you're having to pay another thousand

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or so a month.

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So I want to talk more about the ramifications of

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making the choice to be uninsured if you're uninsured and we're all trained to have

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insurance right we have gotten it from our employers we've purchased it from the

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exchanges and there's never been a time in this country where you have more people

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on the health insurance rolls so it's not just you that are freaking out

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everybody's freaking out the insurance companies are freaking out the um

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Hospital systems are freaking out because if people don't have insurance,

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people aren't going to access care.

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So I'm here to say that it's important for you to consider your options and look at

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the real root of why it is you buy insurance at all.

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So one of the things that people forget about when it comes to a health plan is the

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magic number.

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Now we all worry about the copay or the deductible or the coinsurance or whatever,

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but there's that magic number that most people don't even know that's in a health

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plan.

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And that's this thing called the annual maximum out of pocket.

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So that's the number that once you hit it, the health plan pays a hundred percent.

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of your costs for the remainder of the year and so what that means is if that plan

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if you run as a single person and that plan has a seven thousand dollar

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out-of-pocket maximum once you hit seven thousand dollars the insurance company

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pays a hundred percent of everything for the rest of the year if you're on there

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with a family and the out-of-pocket maximum is fourteen thousand once your family

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hits fourteen thousand

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you know, the plan covers 100%.

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So there are other permutations to that that I won't go into now, but that's the gist.

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You are protected beyond that point.

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Now, one can say, okay, I'm gonna go uninsured.

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If I go uninsured,

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Now I have no upper protection on my out of pocket.

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So for the most part,

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if you're a healthy person and you want to roll the dice,

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you can roll the dice.

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And,

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you know,

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even though that insurance is going to cost you a lot of money,

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even if you go to a bronze level plan,

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it's going to cost you a lot of money.

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You got to decide, well, if that bronze plan is going to cost me now,

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$2,000 a month for my family, that's $24,000 a year.

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I have an annual maximum out of pocket of $14,000.

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So,

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you know,

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you do the math,

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$24,000 plus,

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you know,

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so $14,000,

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that's $38,000 that you could potentially be out of pocket,

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the worst situation.

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So you can say to myself,

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well,

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I'm going to bank all that and put it in a health savings account or just put it in

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an account somewhere to protect it and then pay cash for health care.

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Well, that's a strategy.

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And if you have no assets to protect and you get wheeled into an ER,

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that ER has to take care of you.

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You'll be treated at the ER.

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But it doesn't have a positive connotation for long-term healthcare and chronic

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illnesses that you might need to be treated.

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They'll be covered and the ER will send you a nasty gram,

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the hospital will send you a nasty gram,

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we're gonna collect all these things,

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but they still can't collect blood from a stone if you don't have assets.

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But if you have a house,

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if you have a car,

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if you have money in the bank,

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those are easily targetable assets that they'll come after if you simply decide not

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to pay the bill.

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So the story here is that insurance is there

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truly to protect your maximum risk.

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I don't view insurance anymore as a thing to help me pay that copay or that deductible.

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I always view it now as something that just protects

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my high end and what my annual maximum would be if something bad happens.

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So keep that in mind as you're going through this process.

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Many of you have put yourselves on gold plans and platinum plans.

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And to me,

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that's just money being thrown away and given to the insurance company for free,

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especially if you only access that care once a year for a physical.

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okay if you're someone with a lot going on the benchmark really is take a look at

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that annual maximum out of pocket because bronze plans silver plans some gold plans

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all have the same max out of pocket so no matter you know what plan on what level

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um if you hit that number it's still the same number it might be 8 000 for a single

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16 000 for a family the only difference is you pay more money

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for the gold plan to get to that number slower.

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It's the only difference when they all have the same annual maximum out of pocket.

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So keep that in mind as you're trying to make a decision about whether to buy insurance or not.

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Buy the cheapest plan you can and bank the rest.

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And hopefully the government will come back around and look at

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reinstating these subsidies for you.

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Remember, the subsidies that are in place now are enhanced.

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They were enhanced during the Biden presidency.

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They allow reimbursement for insurance for people with higher incomes.

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It is still a possibility that the next iteration of this is they roll them back to

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the original level of subsidy,

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which is a percentage of federal poverty line.

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So keep all this in mind.

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Stay cool.

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But I would suggest you still buy the cheapest insurance policy possible.

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Now, there are some things out there on the market that you might want to consider as well.

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These are these cost sharing ministry programs.

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I'm not a big fan because, you know, they may or may not

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be able to pay large claims if something really hits, but I have no basis in fact for that.

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That's just anecdotal conversation.

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So keep those in mind, review them, see if you're comfortable with them.

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When it comes to drugs, okay, I'm a big fan of Mark Cuban's Cost Plus Drug Company.

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If the drugs that you are taking are available through that vehicle,

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Take a look at buying your drugs from them, particularly generics.

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Same thing, use a tool like GoodRx.

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GoodRx is something that can geolocate and tell you what a drug costs at all the

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pharmacies within a certain driving distance from your house.

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And believe it,

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there are a vast number of differences between buying it from one pharmacy versus

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another pharmacy versus Costco versus wherever.

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So GoodRx is another good tool to help you look at pharmacy costs and allow you to

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compare prices for places and things that you might need.

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Sometimes even for me, I know that my drugs cost me less buying it through Mark Cuban's deal

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than buying it through my own health plan, which is a high deductible plan anyway.

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So anyway,

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keep all this in mind,

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keep a level head and know that,

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you know,

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this will eventually work its way through,

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but probably not in the timing you need it to make a solid decision for 2026,

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right?

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So my recommendation would be to buy the lowest cost insurance you can to get you through.

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Be smart when you're shopping for your drugs and,

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you know,

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have a good attitude about it,

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even though we all know it stinks.

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So anyway, thanks for listening and take care.

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This podcast reflects the personal views of the host and guests,

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not their employers or sponsors.

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See you next time.