Why Healthcare Keeps Getting More Expensive: Insurance Premiums, Cash Pay Medicine, HSAs, and the Future of Affordable Care

Wondering how to manage rising healthcare costs? Connect with a DevotedDOc physician to explore transparent care options.

By Dr. Matthew Berrios — Founder, DevotedDOc | Healthcare Technology and Policy | Addiction & Specialty virtual care

Most patients experience healthcare costs as a series of unpleasant surprises. The premium rises at open enrollment. The deductible resets in January. A bill arrives months later for an amount nobody mentioned. A physician you have seen for years is suddenly out of network.

None of that is random. Each traces to a specific mechanism in how American healthcare is financed—mechanisms that are knowable but that most patients were never taught. Understanding them will not lower your premium, but it can help you make more informed decisions about the money you already spend on healthcare. Employer-sponsored health plans continue to become more expensive for both workers and employers, highlighting why understanding these costs matters more than ever [23].

This article explains why costs rise, how insurance economics work, what high-deductible coverage means in practice, why physicians leave networks, and how HSAs, FSAs, and transparent pricing fit together for patients and for the employers trying to cover them.

Why Premiums Keep Rising

In 2025, the average annual premium for employer-sponsored family coverage reached $26,993, a 6% increase over the prior year. Workers contributed an average of $6,850 toward that family premium, with employers paying the remaining $20,143. Single coverage averaged $9,325. For comparison, general inflation over the same period was 2.7% and wage growth 4% [1][2]. Roughly 154 million Americans under 65 depend on this coverage [1].

Premiums rise because claims costs rise. An insurer sets next year’s premium by projecting what it will pay out, then adding administrative cost and margin. Several forces push that projection up at once:

• Medical inflation outpaces general inflation. Healthcare prices, particularly hospital services, have historically grown faster than the consumer price index.
• Hospital and physician consolidation. When health systems acquire competitors and independent practices, the resulting entity negotiates from a stronger position. Research consistently associates consolidation with higher commercial prices [3].
• Pharmaceutical spending, especially specialty and GLP-1 drugs. One of the fastest-moving line items in benefit design. In 2025, 19% of large firms covered GLP-1 agonists for weight loss, and employers reported significant concern about the cost [1][2].
• Administrative overhead. Billing, coding, claims adjudication, prior authorization, credentialing, and appeals consume a meaningful share of every healthcare dollar, on both the payer and practice side.
• Chronic disease prevalence and an aging population. More people living longer with more conditions requiring continuous management.

In 2026, average monthly premium payments among ACA Marketplace consumers increased 58%, from $113 to $178, following the expiration of enhanced premium tax credits [26].

Medical Loss Ratio: The 80/20 and 85/15 Rules

One of the most useful things to understand is the medical loss ratio, or MLR, an Affordable Care Act provision governing how insurers must spend premium dollars.

In the individual and small group markets, insurers must spend at least 80% of premium income on medical claims and quality improvement activities. The remaining 20% may go to administration, marketing, and profit. In the large group market, the threshold rises to 85%, leaving 15% [4][5]. If an insurer spends less than the required share on care, it generally owes a rebate to policyholders or, for employer coverage, to the employer.

A WORKED EXAMPLE

An insurer in the individual market collects $100 million in premiums and pays $77 million in claims and quality improvement. Its MLR is 77% (three points below the 80% floor) so it owes roughly $3 million back to policyholders. Had it paid $85 million in claims, no rebate would be owed.

Rebates use a three-year rolling average, so 2026 rebates reflect 2023–2025 experience. Insurers estimated just over $759 million in 2026 rebates across all commercial markets, bringing the cumulative total since 2012 to roughly $15.1 billion. Average payments ran about $233 per person in the individual market, $190 in small group, and $91 in large group [4].

The counterintuitive implication

Read the rule carefully and something uncomfortable appears. If allowable administrative expense and profit is capped as a percentage of premium, the absolute dollars available to the insurer grow when total premium grows. A fixed percentage of a larger number is a larger number.

This is not an accusation of bad faith; MLR rules have returned billions to consumers, but the structure constrains the ratio, not the magnitude, which explains a great deal about why cost containment has proven so difficult.

Important limit: MLR requirements apply only to fully insured plans. Self-funded employer plans — which covered 67% of covered workers in 2025 [1] — are not subject to the rule at all, because in those arrangements the employer, not an insurer, bears the claims risk.

How Employer Coverage Actually Works

Employers fund health benefits through one of three structures, and the differences matter more than most employees realize.

Structure	Who bears claims risk	Typical fit
Fully insured	The insurance carrier. The employer pays a fixed premium regardless of claims.	Smaller employers seeking budget predictability
Self-funded	The employer, which pays claims from its own funds and hires an administrator to process them.	Larger employers with enough covered lives to absorb variance
Level funded	A hybrid. The employer pays a fixed monthly amount covering expected claims, administration, and stop-loss, with potential refund if claims run low.	Mid-sized employers wanting self-funded economics with predictable cash flow

Self-funding is now the norm: 67% of covered workers were in self-funded plans in 2025, including 80% at large firms [1]. These employers buy stop-loss insurance to cap their exposure. Specific stop-loss coverage limits liability for a single individual, while aggregate stop-loss coverage caps total claims across the covered population.

Why one patient can move an employer’s renewal

Consider a 200-employee self-funded company. One employee’s child needs a specialty medication costing $400,000 a year. That single claim can exceed the specific stop-loss threshold, trigger a laser — a higher individual deductible applied to that person at renewal and raise the employer’s stop-loss premium sharply the next year.

The employer then chooses among unattractive options: absorb the cost, raise employee contributions, or raise the deductible. Most do some combination, and the third is most common. This is the mechanism behind a pattern employees experience as arbitrary.

High Deductible Plans: Why You Can Have Insurance and Still Owe Thousands

Four terms account for most surprise medical bills. They are worth knowing precisely.

• Deductible. What you pay before the plan shares costs. In 2025 the average single-coverage deductible was $1,886, up 17% over five years; at small firms it averaged $2,631, with 53% of covered workers facing at least $2,000 [1][2].
• Coinsurance. After the deductible, you typically still pay a percentage — often 20% — of covered costs.
• Out-of-pocket maximum. The annual ceiling on your cost sharing. For 2026, an HSA-qualified high deductible health plan cannot have an out-of-pocket maximum above $8,500 for self-only or $17,000 for family coverage [6].
• Balance billing. When an out-of-network provider bills you for the difference between their charge and what your plan paid. The No Surprises Act restricts balance billing for emergency care and for certain services provided by out-of-network clinicians at in-network facilities, although its protections do not cover every situation [16].

For 2026, a plan qualifies as an HSA-eligible HDHP only if its annual deductible is at least $1,700 for self-only coverage or $3,400 for family coverage, and its out-of-pocket maximum does not exceed $8,500 or $17,000, respectively [6].

So a patient with a $7,500 family deductible who needs a $200 office visit in February pays the entire $200. The insurance is working exactly as designed: it is catastrophic protection, not first-dollar coverage. The gap between what people believe they bought and what they actually bought is where most billing distress originates.

What Happens When Physicians Leave Insurance Networks

Patients often read a network termination as their physician abandoning them. It is almost always contractual.

Network participation generally requires credentialing, which may take 90 to 180 days, followed by a contract that establishes reimbursement rates. Contracts renew periodically and either party may terminate. A practice may decline to renew when rates no longer cover the cost of delivering care or the administrative burden exceeds its value. Insurers likewise restructure networks and terminate contracts.

In the AMA’s 2025 Prior Authorization Physician Survey, physicians reported completing an average of 40 prior authorizations per week, consuming about 13 hours of physician and staff time. Forty percent of practices employed staff dedicated exclusively to prior authorization tasks. Ninety-five percent said prior authorization delayed necessary care, 79% reported that patients abandoned treatment, and 92% said it negatively affected clinical outcomes [7][8].

Add delayed payment cycles, denials, appeals, and the staffing to manage them, and the economics of small-practice participation become difficult. When a contract ends, patients may become out-of-network mid-treatment and receive unanticipated bills. That is a systems failure, not a physician dropping patients.

Understanding Cash Pay Healthcare

Cash pay — also called direct pay or transparent pricing — means paying the practice directly at a published price, with no claim filed. It is neither a criticism of insurance nor a replacement for it, but a different transaction with different properties.

• Price is known in advance. You are told what a visit costs before you have it. No explanation of benefits arrives three months later.
• No prior authorization step. The clinical decision and the treatment are not separated by an approval process.
• Lower administrative overhead. A practice not maintaining billing infrastructure across dozens of contracts has a lower cost structure, and some of that can be reflected in price.
• More clinician time per patient. Volume requirements in insurance-based practice are driven largely by reimbursement rates. Removing that constraint changes visit length.
• Physician autonomy over clinical decisions. Treatment plans are not shaped by coverage criteria written by someone who has not examined the patient.

The honest tradeoffs: cash payments generally do not count toward your deductible or out-of-pocket maximum; they offer no catastrophic protection, and where insurance covers a service well, using benefits is usually the better financial choice. Cash pay is a tool for specific situations, not a substitute for coverage.

Independent practices have moved toward hybrid and cash-pay models for largely arithmetic reasons. Physician-owned practices can often publish transparent pricing, reduce overhead, offer same-day appointments, and serve patients who are uninsured, carry high deductibles, or whose physician has left their network. DevotedDOc operates on that model not because insurance is the enemy, but because for a defined set of situations the simpler transaction produces better access.

Health Savings Accounts: The Most Underused Tool in Healthcare Finance

An HSA is a tax-advantaged account for individuals enrolled in a qualifying high deductible health plan without other disqualifying coverage. Eligibility rules are set by the IRS in Publication 969 [9].

The 2026 numbers

• Contribution limit: $4,400 self-only, $8,750 family, plus a $1,000 catch-up contribution at age 55 and older [6].
• Qualifying HDHP minimum deductible: $1,700 self-only, $3,400 family [6].
• Qualifying HDHP out-of-pocket maximum: no more than $8,500 self-only, $17,000 family [6].

The triple tax advantage

Contributions are pre-tax or tax-deductible, growth and earnings are tax-free, and withdrawals for qualified medical expenses are tax-free. No other account offers all three. After 65, non-medical withdrawals are permitted and taxed as ordinary income, while medical withdrawals remain tax-free.

What recently changed, and why it matters

The One Big Beautiful Bill Act, signed July 4, 2025, permanently amended Section 223 of the Internal Revenue Code to restore the telehealth safe harbor. Effective for plan years beginning after December 31, 2024, an HDHP may cover telehealth and other remote care before the deductible is met without disqualifying the participant from HSA contributions. IRS Notice 2026-05, issued December 9, 2025, provides implementing guidance and clarifies that qualifying services are those on the Medicare telehealth services list [10][11].

This matters. Between the expiration of the temporary CARES Act safe harbor and this law, employers offering pre-deductible telehealth risked making employees ineligible for HSA contributions. That conflict is now permanently resolved.

Two related changes: HSAs may now reimburse qualifying direct primary care fees as medical expenses, though employer-paid fees including salary reduction are not reimbursable. And from January 1, 2026, bronze and catastrophic Exchange plans are treated as HDHPs for HSA purposes even where they do not meet traditional deductible thresholds [10][11].

What HSA funds can pay for

Qualified medical expenses are defined in IRS Publication 502 [12] and generally include office visits and telemedicine consultations, prescription medications, laboratory testing, behavioral health care, and substance use disorder treatment. Insurance premiums generally do not qualify, with narrow exceptions including COBRA, coverage during unemployment, and Medicare premiums after 65.

Whether a specific service qualifies depends on IRS rules and the facts, not on how a practice markets itself. Weight management, for example, may qualify when treating a physician-diagnosed condition and may not otherwise. Verify before assuming.

How reimbursement actually works

Patients often do not realize they have two options. Pay directly with an HSA debit card at the point of service or pay out of pocket, keep the receipt, and reimburse yourself later, with no deadline. A qualified expense incurred today can be reimbursed years from now, provided it was incurred after the HSA was established and you retain documentation.

That second option is an underappreciated strategy: pay out of pocket, let the balance grow tax-free, reimburse yourself later. This strategy requires disciplined recordkeeping, so keep every receipt indefinitely.

Flexible Spending Accounts

An FSA is employer-sponsored and differs from an HSA in ways that matter:

	HSA	Health FSA
Requires HDHP enrollment	Yes	No
2026 contribution limit	$4,400 self-only / $8,750 family	$3,400 employee salary reduction
Ownership	Yours; portable across jobs	Employer-sponsored; generally forfeited at separation
Unused funds	Roll over indefinitely; may be invested	Use-it-or-lose-it, with limited relief
Availability of funds	Only what has been contributed	Full annual election available on day one

For 2026, the health FSA salary reduction limit is $3,400, with a maximum $680 carryover into the following plan year per IRS Revenue Procedure 2025-32 [13]. Employers may offer a carryover or a grace period of up to two and a half months, but not both.

A dependent care FSA is a separate account for childcare and eldercare, not medical care. For 2026, the dependent care assistance limit increased from $5,000 to $7,500 for married couples filing jointly and from $2,500 to $3,750 for married individuals filing separately [14].

Health Reimbursement Arrangements

An HRA is funded entirely by the employer, which reimburses employees for qualifying medical expenses up to a set amount. The funds are not the employee’s property and generally do not transfer at separation.

Two variants matter. An Individual Coverage HRA lets an employer reimburse individual market premiums and medical expenses instead of offering a group plan increasingly common among small employers. An Excepted Benefit HRA reimburses certain expenses alongside a group plan, with a 2026 maximum employer contribution of $2,200 [6].

HRA design varies substantially. Whether an expense qualifies for reimbursement depends on the specific plan document, so review it rather than making assumptions.

Using Cash Pay Care With an HSA or FSA

These are not mutually exclusive, and the combination is where much of the practical value sits for patients with high deductibles.

1. Pay the practice directly. Use an HSA or FSA debit card at the point of service, or pay by another method.
2. Obtain an itemized receipt. It should show the date of service, patient name, provider name, description of the service, and amount paid.
3. Determine whether the expense qualifies. Check IRS Publication 502 and your plan documents.
4. Submit for reimbursement, or reimburse yourself. FSAs typically require submission to the administrator. HSAs generally allow self-reimbursement at any time.
5. Retain documentation. The account holder, not the provider or administrator, is responsible for substantiating that a distribution was for a qualified expense.

This is general educational information, not tax advice. Qualified medical expense determinations depend on individual circumstances and current IRS rules. Consult a qualified tax professional and review IRS Publications 502 and 969 before relying on any of the above.

How This Plays Out in Practice

The high deductible

A family carries a $7,500 deductible. In March, a parent needs management of newly elevated blood pressure. Through insurance, the visit and labs apply to the deductible and are paid entirely out of pocket at negotiated rates the patient learns after the fact. At a transparent-price practice, the cost is known beforehand and payable by HSA card. The cash payment does not count toward the deductible — a real tradeoff — but the price is knowable in advance.

The employer plan change

An employer moves from fully insured to level funded after a costly claims year and raises the deductible from $2,000 to $5,000. An employee managing hypertension, hyperlipidemia, and depression now faces the full cost of routine follow-up, where transparent pricing can be the difference between continuing treatment and stopping.

The network termination and the authorization delay

A physician of eleven years does not renew a payer contract, and the patient becomes out-of-network. They can start over with an in-network physician or continue with the same clinician on a cash-pay basis. The point is that the second option exists. Separately, a medication requiring prior authorization is denied, appealed, and resolved three weeks later, during which the patient goes untreated. For time-sensitive conditions—opioid use disorder being one of the clearest examples—that delay is not merely inconvenient. It can be dangerous.

The employer that changes approach

A self-funded employer adds pre-deductible telehealth coverage, now permanently permitted alongside HSA eligibility. Employees reach virtual primary care and behavioral health without first meeting a $3,400 family deductible — and the plan design no longer penalizes seeking care early.

Is Cash Pay Healthcare Replacing Insurance?

No—and any argument that it is should be treated skeptically.

Insurance exists to protect against catastrophic cost. Cardiac surgery, cancer treatment, a prolonged ICU stay, or a serious pregnancy or birth complication can cost hundreds of thousands or even millions of dollars. to hundreds of thousands or millions of dollars. No transparent-pricing model addresses that, and no responsible physician would advise dropping coverage for cash pay.

Situation	Generally better served by
Catastrophic and inpatient care, surgery, oncology	Insurance — without exception
Emergency care	Insurance, with No Surprises Act protections
Specialty and hospital-based care	Insurance
Routine primary care under a high deductible	Either; compare transparent price against deductible exposure
Chronic disease medication management	Either; cash pay often simpler and faster
Behavioral health and addiction treatment	Either; cash pay avoids authorization delay and improves privacy
Care when uninsured or between jobs	Cash pay, as a bridge
Care when your physician has left the network	Cash pay, to preserve continuity

The realistic future is hybrid: carry insurance for catastrophic protection, and use transparent pricing selectively for predictable lower-cost services where a deductible means insurance would not pay anyway. That is arithmetic applied to a plan design, not an ideological position.

Where Telemedicine Fits

Virtual care lowers cost by removing overhead, not by cutting clinical corners. No facility fee, no waiting room, far less billing infrastructure. Combined with published pricing, the cost of an episode becomes knowable in advance.

Physician-owned telemedicine practices can generally offer transparent pricing, same-day appointments, chronic disease management, behavioral health, and addiction treatment including buprenorphine and naltrexone, and can coordinate laboratory testing and prescriptions where clinically appropriate and legally permissible where clinically appropriate and legally permissible. That qualifier is not boilerplate — controlled-substance prescribing through telehealth is governed by federal requirements and applicable state laws, which may vary by location [19]. Any practice describing these services should be able to tell you exactly what it can do in your state.

The populations served best are specific: patients with high deductibles who will pay out of pocket regardless, the uninsured, those between jobs, those whose physician has left their network, and those for whom an authorization delay carries clinical risk.

A Physician’s Perspective

Emergency medicine gives you an unusually clear view of what the financing system produces, because you see the failures rather than the averages. The patient whose blood pressure medication lapsed when the plan changed. The patient who waited on an authorization and arrived in crisis. Also, the patient who skipped a follow-up because of a deductible and assumed the visit would cost more than they had.

What struck me was how much of the harm was administrative rather than clinical. The medicine was not the hard part. Hypertension is manageable. Opioid use disorder is treatable. Depression responds to treatment. The failure point was almost always a process between the patient and the care — a coverage determination, a network change, a cost the patient could not predict and therefore avoided entirely.

Clinical informatics reinforced the same conclusion from the other direction. Every additional step in a workflow loses people — a measurable property of systems, not a moral claim about patients. If obtaining a medication takes seven steps, fewer people finish than if it takes three, and those who drop out are disproportionately the ones with the least slack in their lives.

So the design question I care about is not whether care is virtual or in person, or cash or insurance. It is how many steps stand between a person recognizing they need help and receiving it. Reducing that number is the most reliable quality intervention I know of. That is what DevotedDOC was built to do, and it is why transparent pricing matters to me — an unpredictable price is itself a step, and often the one where people stop.

— Matthew Berrios, DO

What to Do With This Information

6. Read your Summary of Benefits and Coverage. Know your deductible, coinsurance, and out-of-pocket maximum before you need care, not after.
7. Determine whether you are HSA-eligible. If you are eligible and not contributing, you are declining the only triple-tax-advantaged account in the tax code.
8. Ask whether your plan covers telehealth pre-deductible. It is now permanently permitted, and many employers have not yet adopted it. Asking is how plan design changes.
9. Compare the transparent price against your actual exposure. Under a high deductible, the cash price is sometimes lower than the negotiated rate you would pay yourself.
10. Keep every medical receipt. HSA self-reimbursement has no deadline, and documentation is your responsibility.
11. Do not delay care because of cost uncertainty. Waiting can become the most expensive decision available. Nearly everything I have watched become an emergency was manageable, and cheaper, earlier.

Healthcare financing is complicated because it was assembled in pieces over decades, not because the complexity serves patients. The individual mechanisms are learnable, and knowing them changes what you can do with money you are already spending. To see how physician-led, transparently priced telemedicine fits your situation, [learn more about DevotedDOC’s services] — and compare it honestly against what your coverage already provides.

References

• [1] Kaiser Family Foundation. 2025 Employer Health Benefits Survey. October 2025. https://www.kff.org/health-costs/2025-employer-health-benefits-survey/
• [2] Claxton G, et al. Health Benefits In 2025: Family Premiums Rise 6 Percent, Large Employers Increase Coverage Of GLP-1s For Weight Loss. Health Affairs. 2025. https://pubmed.ncbi.nlm.nih.gov/41122830/
• [3] Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy. Section addressing provider consolidation and commercial healthcare prices. https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/mar20_medpac_ch15_sec.pdf
• [4] Kaiser Family Foundation. 2026 Medical Loss Ratio Rebates. 2026. https://www.kff.org/private-insurance/medical-loss-ratio-rebates/
• [5] Centers for Medicare & Medicaid Services. Medical Loss Ratio requirements under the Affordable Care Act. CMS.gov. https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio
• [6] Internal Revenue Service. Revenue Procedure 2025-19: 2026 inflation-adjusted amounts for HSAs, HDHPs, and excepted benefit HRAs. May 1, 2025. https://www.irs.gov/pub/irs-drop/rp-25-19.pdf
• [7] American Medical Association. 2025 AMA Prior Authorization Physician Survey. Released May 2026. https://www.ama-assn.org/practice-management/prior-authorization/ama-prior-authorization-physician-survey
• [8] American Medical Association. AMA Survey: Prior Authorization Reform Pledge Falls Short for Physicians. Published May 13, 2026. https://www.ama-assn.org/press-center/ama-press-releases/ama-survey-prior-authorization-reform-pledge-falls-short-physicians
• [9] Internal Revenue Service. Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans. https://www.irs.gov/forms-pubs/about-publication-969
• [10] Internal Revenue Service. Notice 2026-05: Guidance on HSA provisions under P.L. 119-21. December 9, 2025. https://www.irs.gov/pub/irs-drop/n-26-05.pdf
• [11] Public Law 119-21 (One Big Beautiful Bill Act), Section amending 26 U.S.C. § 223. Enacted July 4, 2025. https://www.congress.gov/119/plaws/publ21/PLAW-119publ21.pdf
• [12] Internal Revenue Service. Publication 502: Medical and Dental Expenses. https://www.irs.gov/forms-pubs/about-publication-502
• [13] Internal Revenue Service. Revenue Procedure 2025-32: 2026 health FSA contribution and carryover limits. October 9, 2025. https://www.irs.gov/pub/irs-drop/rp-25-32.pdf
• [14] Internal Revenue Service. Publication 15-B (2026): Employer’s Tax Guide to Fringe Benefits. https://www.irs.gov/publications/p15b
• [15] Centers for Medicare & Medicaid Services. National Health Expenditure Data and Projections. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data
• [16] American Medical Association. Implementation of the No Surprises Act. Updated May 18, 2026. https://www.ama-assn.org/health-care-advocacy/access-care/implementation-no-surprises-act
• [17] Congressional Budget Office. Reports on health insurance coverage and federal subsidies. https://www.cbo.gov/publication/62539
• [18] Government Accountability Office. Reports on health care price transparency and consolidation. https://files.gao.gov/reports/GAO-25-106995/index.html
• [19] U.S. Department of Health and Human Services. Prescribing Controlled Substances via Telehealth.  https://telehealth.hhs.gov/providers/telehealth-policy/prescribing-controlled-substances-via-telehealth
• [20] Substance Abuse and Mental Health Services Administration. TIP 63: Medications for Opioid Use Disorder. https://www.samhsa.gov/resource/ebp/tip-63-medications-opioid-use-disorder
• [21] American Society of Addiction Medicine. National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. https://pubmed.ncbi.nlm.nih.gov/32511106/
• [22] Mercer. 2026 HSA, HDHP and excepted-benefit HRA figures. Law and policy analysis. https://www.mercer.com/insights/law-and-policy/2026-hsa-hdhp-and-excepted-benefit-hra-figures-set/
• [23] Milliman. 2026 Milliman Medical Index: Annual Analysis of Healthcare Costs for People Covered by a Typical Employer-Sponsored Health Plan. https://www.milliman.com/en/insight/2026-milliman-medical-index
• [24] American Academy of Family Physicians. Direct primary care resources and policy. https://www.aafp.org/about/blog/lovins-dpc
• [25] National Association of Insurance Commissioners. Medical Loss Ratio overview. https://content.naic.org/insurance-topics/medical-loss-ratio
• [26] KFF. What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles.  https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/

Disclaimer: This article is for general educational purposes. It does not constitute medical, tax, legal, or financial advice, and it does not establish a physician-patient relationship. Tax treatment of medical expenses depends on individual circumstances; consult a qualified tax professional and review current IRS guidance. Insurance and regulatory provisions described here are subject to change. Figures are current as of the publication date noted above.