How to Avoid Insurance Surprises in 2027

Released Oct. 13, 2026 

PODCAST OPEN: Thank you for tuning in to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. You may have arthritis, but arthritis doesn’t have you. Here, you’ll get information, insights and tips you can trust — featuring volunteer hosts and guest experts who live with arthritis every day and have experience with the challenges it can bring. Their unique perspectives may help you — wherever you are in your arthritis journey. The Arthritis Foundation is committed to helping you live your best life through our wide-ranging programs, resources and services. Our podcast is made possible in part by the generous financial contributions of people like you. Now, let’s listen in. (MUSIC BRIDGE) 

Alisa Casavant: Hi everyone, and welcome to the Live Yes! With Arthritis podcast. I'm Alisa Casavant, senior director of policy at the Arthritis Foundation, and I am here today with my colleague, Nick Turkas, our senior director of patient education and community connections. Today, we are excited to talk about one of everybody's absolute favorite topics, health insurance. 

Nick Turkas: Ooh, I can already feel the excitement. 

Alisa Casavant: (laughs) Stick with us, because as thrilling as premiums, formularies and prior authorization may sound, this stuff has a very real impact on people's lives, especially when you're managing ongoing health conditions. The health plan you choose can affect which doctors you see, whether your medications are covered, how much you pay and sometimes even how many hoops you have to jump through in order to get the care you actually need. 

I come from this from both the policy side and the patient side. I do lead our policy work here with the Arthritis Foundation, so I spend a lot of time in the weeds on Medicare, Medicaid, Marketplace coverage and all of the glamorous policy topics. I also am a patient. I have a L5-S1 spinal fusion that I received at age 33, and lumbar degenerative disc disease and spinal stenosis. Nick is here to really bring the less nerdy, wonky lens for us. And I can tell you what Congress or the health administrations have changed, and Nick is here to get us from, "OK, great, but what do I actually do with that information, Alisa?" So, Nick, can you tell us a little bit about your role and kind of the lens that you're bringing today? 

Nick Turkas: Sure. In addition to a long tenure at the Arthritis Foundation, I actually spent a year working for a health insurance company. My role in the Arthritis Foundation involves patient education and navigation, helping people understand the health coverage that they have, how to compare plans and really translating insurance into practical health decisions to make sure that you get the best care that you deserve. 

Alisa Casavant: So, let’s start with the basics, because health insurance has a remarkable ability to take what feels like a straightforward question — like “Will this health plan pay for the care that I need?” — and turn it into approximately 5,000 vocabulary words. Nick, what terms do you really need to know? What should people understand? 

Nick Turkas: Yeah, happy to help. Yes, there are definitely some terms that can be confusing, and I want to make sure that everyone understands things like premium, deductible and copay. Those are probably the top three. And you can think of a premium as a membership fee. That's what you have to pay every month in order to keep your health insurance. There's also a deductible, and a deductible is the amount of money that you have to pay first before the insurance company is going to start to kick in. And then there's a copay. And copay means that we are paying together — both the insurance and you, as the user of insurance. 

Other words like co-insurance, and that's a percentage of the cost of care. Out-of-pocket maximum, and that just means how much you're going to have to pay typically in a year before health insurance will cover everything else. Your network is: Think of all of the healthcare providers that will serve you — your doctors and pharmacies, even physical therapy locations. And your formulary is a list of the medications that are on the list for your health insurance. 

Alisa Casavant: And I think actually, Nick, you and I had created a glossary of terms for common health insurance words that is now on the Arthritis Foundation's website. Is that right? 

Nick Turkas: That's right. 

Alisa Casavant: I do really want to underline here that the plan with the lowest monthly premium, or that regular fee that might come out of your paycheck or that you're paying every month, is not automatically the least expensive plan overall, right? 

Nick Turkas: Absolutely. I think that can be a trap for a lot of people. Many people look at the monthly premium, and they really want to keep that number very low. But the reality is that you're going to be probably paying for many other things throughout the year. I would say a general rule is that the lower the monthly premium, the higher all of the other costs are going to be any other time that you use your healthcare. So, if you don't use your healthcare very often, a low premium is probably a good thing for you. But for many people listening to this podcast, people with arthritis and other chronic diseases, in general you're going to be one of the higher users of healthcare. And so, by tapping into more appointments, more visits, more medications, surgery, all of those extras are going to have a much higher cost than if you were to pay a higher monthly premium. So, you really need to look at your budget and what makes the most sense for you. 

Alisa Casavant: That's really helpful, Nick. Thank you. Another piece that I think a lot of people might miss is, even if you have the same health insurance company or even the same plan name, the details underneath of it might change every year. So, like Nick was saying, your healthcare provider network could change or your drug formulary could change. Are my medications still insured at the same level? Or did it move tiers and now I have to pay a different price or out-of-pocket cost for it? Things like your pharmacy can change. Sometimes the options are narrowed. Sometimes you have to change specialty pharmacies. There can also be other new updates around prior authorization or step therapy requirements and, of course, your costs. So, if we wanted to give everyone a really simple open enrollment checklist, maybe like five things that everyone should know, Nick, what would you put on it? 

Nick Turkas: Absolutely. First, check your doctors and your specialists. Who are the doctors that you're seeing on a regular basis? Who is your primary care physician? If you have a specialist that you see regularly, check to see if they're still on your network. And you can look on the insurance provider's guide, or you can call those providers directly and just ask. Next, you're going to look at your medications, and you want to see: Is your medication on the list? And it may have changed its tier, right? So, there are preferred medications, and then there are medications that may require prior authorization or a higher cost. You want to make sure not only is your medication on the list, but where is it listed as far as a cost? 

Next, you want to look at your pharmacy and infusion sites. Where are you going to pick up your medication or receive your medication from infusion? And again, expected care next year. Are you planning on having a joint replacement surgery or a back surgery? Are you thinking about a fusion? Do you need outpatient surgery for any of the issues that you're having with your arthritis? Do you expect to go out of network because of travel? Another unexpected cost that you should probably budget for is a visit to urgent care or the emergency room. It's better to plan for it and not need it than not have it and then be burdened with that extra cost. 

Alisa Casavant: And also don't forget: A lot of people living with arthritis also have other conditions, so you want to factor in your total healthcare cost. That's what Nick's talking about. So, OK, excellent. Keep those in mind. Doctors, drugs, pharmacy, expected care and total cost. So now, let's put some of these into situations where people can actually use them in real life. Scenario one, and honestly, I deeply relate to the energy of this one. For example, I love my doctor. My medications are working. Nothing catastrophic happened with my insurance this year. I like my plan. And my plan says it's renewing. So, can I just click yes and move on with my life? Nick, if someone is genuinely really happy with their coverage, how much reviewing do I really need to do? (laughs) 

Nick Turkas: You need to check and verify, right? And that's, again, checking on your doctors. Are they on the in-network? Looking at your medications. You may even want to ask your doctor, "Do you anticipate that these medications will change?" Or is an expensive medication that you're currently taking going to be become a generic and maybe cost a little bit less? Your pharmacy benefit, again, when you're checking, when you're picking up your meds, you just might want to just ask, "Next year, is this pharmacy still going to be part of my plan? Have you heard anything?" And again, look at those overall costs. Again, premium and deductibles and copays, co-insurances, those costs can sometimes sneakily increase year to year, and it's a good idea to just double check them. 

Alisa Casavant: Staying with your plan may absolutely be the right choice. We're simply saying verify before you renew. Take a double check. If you finally found a rheumatologist that you trust or a treatment that works, those are exactly the things that you want to make sure that you're protecting. And this is not hypothetical. Desiree Constantino, who responded to us, had said that one of her biggest worries is a plan changing its formulary and suddenly making a medication that she's relying on unavailable or harder to access. If I know that there is a medication that I really need and is working for me, again, what should I be checking for specifically before I hit renew? 

Nick Turkas: That's right. Is this medication covered? And at what level is it covered? What tier is it at? Is it a preferred medication, or is it a medication that requires a higher cost or something called a prior authorization? I know for my own family, there's medication that we use and our physician has prescribed it for years, but every single year we have to go through the dance of prior authorization. And so, just being prepared for that is another thing that can help with the cost of your time. 

Next is step therapy. This might be something for… If a doctor is going to introduce a new medication to you, do you have to fail on a different medication first? Typically, that next step medication is going to have a higher cost, and you need to know what that is. And then there's another thing that you might want to have to think about, and that's specialty pharmacy requirements. You know, are you going to use a specialty pharmacy because you're using some of these high-powered medications for autoimmune disease, rheumatoid arthritis, psoriatic arthritis? Those conditions can often require us to use a different type of pharmacy benefit and what the cost of those medications is. 

Alisa Casavant: And all of those are issues that the Arthritis Foundation is working on improving for patients. In the advocacy team, those are some of our top priority issues. So, if you are excited to learn more, jump on our website and sign up to be an Advocate. 

PROMO: As an Arthritis Foundation Advocate, you can help raise awareness about the unique challenges people with arthritis face. Advocates play a vital role in influencing policy changes that promote better health care options and reduce barriers to treatment. Help ensure that everyone with arthritis receives the care and support they need to live their best life. Sign up at arthritis.org/advocate. 

Alisa Casavant: Let's say someone gets insurance through their work and they have two or three options. Any other tips or tricks of the trade that I could use when I'm comparing? Do I literally put them side by side and, like, estimate my dollar signs? How do you do this? 

Nick Turkas: In a perfect world, yes. You would really want to compare those costs side by side by side, and really looking at what the cost of the premium is, so what is the cost of that monthly fee? And then every time you use your insurance, how much it's going to cost with those copays and possibly co-insurance. And also looking ultimately at that out-of-pocket maximum: What's the most that you would have to pay? Broadly speaking, if a lower premium is going to be accompanied with higher costs anytime you use that care. In general, if you are someone that has lots of doctors and lots of doctor's appointments, typically that lower premium is not going to save you money in the long run. It is probably better to spend a little bit more on the monthly premium and have much lower costs that happen every time that you visit a healthcare provider. 

And let me say why this is so important. This, what we call utilization management, it can often play a little bit of a mental game for you, because, if you know every time that you have to go to the doctor or go to therapy or pick up a medication that you're going to have a high cost, there's a chance that you might say, "Maybe I don't need to go, or maybe I can go without." And that can have very serious long-term health consequences. And I really want to emphasize how important it is for you to get all the care that your provider thinks you need and you deserve. So, please budget appropriately to not limit the amount of medication, health advice, coaching and coverage that you deserve as a patient living with arthritis or any other health condition. And so, you want to make sure that you don't limit yourself even mentally because of those high out-of-pocket costs. 

Alisa Casavant: When I'm looking at my maximum out-of-pocket costs, does that mean the amount that I, Alisa, am literally putting down with a credit card? 

Nick Turkas: In some cases, yes. There are some people that are going to reach their out-of-pocket maximum within the first month… 

Alisa Casavant: January. 

Nick Turkas: ...of their care. Right. Because they have a medication, they have a surgery, it's a very high cost. Or because it may not be fully covered by insurance. And that word “covered” is sort of a trigger word for me because, in the health insurance world, “covered” is a word that doesn’t really mean anything, because that doesn’t really tell you how much anything specifically costs. I always encourage people to not ask if this is covered. Ask “What will this cost and what will it cost me?” That’s a much better word, because you’ll hear lots of things are covered, but really what you’re paying out of pocket can be a very high cost. 

Alisa Casavant: I love that tip though, Nick. Because a lot of times, you know, we travel. My family lives out of state, and I might be out of network, but they'll still tell me I'm covered. 

Nick Turkas: Covered. That's right. Covered is such an easy thing for, you know, in marketing of these plans to say, but the reality is: What are those out-of-pocket costs? And when you have a high out-of-pocket cost, you anticipate perhaps you're going to pay all at once in the first month or two. A, are you budgeting for that? And B, are you talking to your providers about a payment plan? And in many cases, that is something that is available. So, never, never hesitate to reach out. A, when it comes to understanding your plan, when you're going through these plans and you don't understand what something will cost or what you'll use, honestly, I recommend you pick up the phone. It's so much easier to talk to a human being and ask them. Call your insurance company. There's a phone number on the back of your card. Or call your physician and ask to speak to someone that can help you better understand it. And that time is just so worth it. 

Alisa Casavant: And another thing with out-of-pocket costs, Nick, are copay accumulators. It is a really intimidating word, and I know that most of us have never heard this before. But we heard from Bree Fredrickson, who was specifically worried about these copay accumulator policies. She has a self-funded employer plan, so the manufacturer assistance that she's receiving can help to pay for some of her medications but does not necessarily count toward her deductible or her out-of-pocket max. 

Copay accumulator policies can create some big affordability issues, especially when you go to the pharmacy to pick up your meds and you think, "Oh, you know, my manufacturer or my third-party assistance is covering this." Just to find out later on, your plan actually has you on a copay accumulator policy and now you have to pay out of pocket because they weren't accepting those third-party funds to help provide it. So, if you are unsure, ask your questions. Call your doctor, call the Helpline with the Arthritis Foundation. We'll share that number at the end and in the show notes. 

Speaking of expensive medications: Medicare. It brings us a whole other version of affordability questions. Those of you that have Medicare or expect to be enrolling in Medicare for the first time, Medicare open enrollment this year runs from October 15th through December 7th, and there are changes that generally take effect and start January 1st. In 2027, there are two numbers that are worth knowing. The first is $700. That is the standard Part D as in drug deductible. That is your prescription drug amount that you have to pay before Medicare will start covering the rest of your meds. The second number is $2,400. That is your annual out-of-pocket threshold for those Part D medications that are covered. So, once you hit that $2,400 threshold for your covered medications, you don't have to keep paying additional cost sharing like your copay or your co-insurance rate for those covered drugs for the rest of the plan year. 

Now, I personally hear a number like 2,400, and I immediately think, "Great, but when do I need to have $2,400, because the total cost and the cash flow are two totally different problems, right?" This is where the Medicare prescription payment plan, or MP3, MPPP, there are a lot of different names, but it might be helpful for you. It can let people with Part D spread out their out-of-pocket prescription drug costs across a monthly payment instead of as one very large bill upfront early in the year at the pharmacy. 

For people that are expecting to hit their maximum out-of-pocket cost with Medicare in January or March or even April, it could be interesting for you to check out and see if you could spread that cost throughout the entire plan year on a monthly payment instead of paying the entire $2,400 in the spring. Now, one important distinction here is that this can help with when you pay. It does not necessarily reduce the total that you will owe. So, you'll owe the same amount, but you can spread it out a little bit easier. One thing I want to make sure to impress upon you is that Medicare prescription payment plan is separate than Medicare. You do have to opt-in for the MP3 plan even if you're already enrolled in Medicare. So, make sure if you're interested in spreading out those costs for your prescription drugs over the year, you have to enroll in that program separately. 

We also heard from Jenny Schaefer, who is worried about what she's going to owe on her infusions after Medicare pays and about not having access to the same manufacturer assistance that she had when she was with her commercial health insurance through her employer. So, I want to flag here that, because not every arthritis medication fits neatly into the Part D Medicare discussion that we just had, infused medications might be covered differently, depending on the drug and where it's administered. Is it in a doctor's office? Is it something I can pick up and do myself at home? And then, which Medicare benefits apply? So, Nick, this feels like one of those sticky situations where individualized health really matters. But how do I start if I don't know where to go, specifically for Medicare? 

Nick Turkas: Moving to a Medicare plan can be confusing for many people, but the good news is there's lots of help. In fact, one of the best resources is a SHIP counselor, and SHIP stands for the State Health Insurance Assistance Program. They typically work for the state or work for an area agency on aging. And they can provide individualized advice about choosing a plan. But they also typically have lots of health fairs and educational events that happen all through the fall, because that's right before open enrollment. You'll typically see these events in senior centers and libraries and YMCAs in your state, and they can really help you make this decision. 

There's also… Typically every state has a 1-800 number that you can call or a great website that you can check out. And again, they're going to help you make a decision about insurance without necessarily selling you a plan. You also want to think about where can you get your coverage, right? Are you going to have to change any doctors, change any places that you get therapy or pick up your medications? Those are really important questions to ask. And you also might want to look at Arthritis Foundation resources. 

Alisa Casavant: So, I think what I'm hearing, Nick, is the broader message is: Don't assume that the Part D rules we just talked about apply identically to every treatment that you might be getting. And I really like the reminder about some of the support that we have, including the Arthritis Foundation's Helpline, because there are so many parts to different Medicare plans. 

Nick Turkas: My SparkNotes on Medicare would be really looking at: Are you going fee for service, or are you going Medicare Advantage plan? And both of them have advantages. Again, Medicare Advantage plans are managed care, so just be aware that if you use a lot of care, a Medicare Advantage plan may have a lot of extra costs whenever you are visiting a healthcare provider. 

PROMO: The Arthritis Foundation’s Arthritis@Work program is a free service designed to help companies support employees with arthritis, so they can stay productive and feel confident at work. This program provides businesses with valuable resources, tools and strategies for creating an arthritis-friendly workplace. Go to arthritis.org/atwork to learn more. 

Alisa Casavant: For someone with arthritis, thinking about potential imaging or physical therapy or procedures that are other medical services, prior authorization is something that you're going to want to pay attention to. Some might just be for medical items, some might be for procedures and services, and some might be for prescription drugs, and they can all be different forms of prior authorization. So, let's shift from Medicare to people who buy their own health insurance through Marketplace plans. First, a quick translation, you might hear all of these terms: Marketplace, ACA Marketplace, Exchanges. Broadly, we're talking about the same place where you can shop for individual coverage. If you're not getting coverage through something like Medicare, Medicaid or your employer, you might be able to sign up for Marketplace or Exchange coverage. For states that are using healthcare.gov, uh, open enrollment for 2027 begins November 1st, so coming up very quickly, and runs through January 15th. 

And the biggest things that you're going to notice this year is cost. That's the number one thing that we're hearing across the board. A lot of the changes that happened since the COVID-19 pandemic, like enhanced premium assistance for people, is no longer available in the same way that it used to be. Some families might be looking at a very different price tag coming up. And we're already hearing directly from patients about those concerns. 

Rosemary Cox Mays has responded and let us know that she's worried about her Marketplace premium really dramatically increased, but the deductible and the out-of-pocket exposure were still also really high. And I think that it's important, because I don't want our message to sound like, "Just shop smarter and everything will be fine," because sometimes every available option is still expensive. And for a lot of people and a lot of families, these are really difficult decisions if you have a limited household budget, like most of us do. 

So, if you're using, or plan to use, Marketplace coverage, make sure that you're updating your expected household income and your income information. If you had a kid or you got married, make sure you add that in and compare those options again. The goal is not to find some mythical, perfect health insurance plan. It probably doesn't exist, unfortunately, as much as we would love to make that happen. But the goal really is to try to understand some of those trade-offs. Like Nick was saying, if your premium goes up, if my other costs go down or vice versa. Check out healthcare.gov or your official state Marketplace. If you're planning to do Marketplace insurance enrollment, that's where you want the current information that actually applies to you. So, Nick, affordability is the hot topic. But how do I compare imperfect options? There's no great health plan for me. Is there anything that I can do? 

Nick Turkas: I would encourage you to look at all of the plans, and look at what you can afford if you do have to perhaps drop down a tier. That is better than no coverage at all, because remember that there's no avoiding healthcare costs, right? We can't just wish that these costs go away. Can you maybe ask more questions at a healthcare visit than you typically do? Ask your provider about telehealth options. Ask your provider, is it OK if you ask questions through the MyChart app instead of going in for a visit that may cost a copay? You may ask a physical therapist after a couple of sessions, "Can you create a plan of exercises that I can do at home instead of going in?" 

I don't want to limit care. I just want us to think about: How can we maximize the time we have with healthcare providers? We also may want to think about our pharmacy benefits. Would it be cheaper to get a 90-day supply than going into a retail pharmacy for a monthly supply? Little things like that aren't going to necessarily save you millions of dollars, but every penny counts when it comes to healthcare. So, really look at your plan, look at your options and look at where you're using care. And how are there ways that you can make the most of it every single visit? 

Alisa Casavant: I can definitely save some sanity, too. I just switched from monthly prescription pickup to 90-day finally, and it has really saved on gas. You know, driving to the pharmacy is 20, 30 minutes away for people, and that can add up really quickly, too. 

Nick Turkas: Yeah, there are pharmacies that are more than happy to deliver your medication to you from your retail pharmacy. So, take advantage of all of those benefits. 

Alisa Casavant: The telehealth was a good tip, too. Thanks. So now, we need to talk about Medicaid, because this is probably the biggest new eligibility conversation for 2027. And I want to start this section very, very clearly, because there has been a lot of shorthand about Medicaid work requirements. And I want to make sure that people understand what these mean. These requirements do not apply to everyone who has Medicaid. But people's health, caregiving responsibilities, your employment situation, other circumstances, your education, are you currently in school, part-time, full-time — those can all vary quite enormously. The key fact, the key thing you need to know for Medicaid, is that starting in 2027, a certain group of adults aged 19 through 64 might be subject to new work, or quote, official term, “community engagement requirements.” 

So, for people who are subject to that requirement, the federal standard is generally 80 hours per month. Qualifying activities can be things like work, education, certain work programs, community service. There are exclusions and exemptions for individuals based off of your situation. And for our community, an arthritis diagnosis by itself doesn't tell us a lot. It doesn't tell us everything about someone's circumstance or whether that requirement applies, because we all know sometimes you get a flare and it doesn't, you know, necessarily last for the entire year. Maybe it's episodic pain, and you can't work for a month or two, but you could work the rest of the year. We all experience our arthritis very differently, and these rules include exemptions and exclusions. They might apply differently for somebody else who has the same exact condition. 

So, you're going to want to check on states. Every state will be implementing and documenting things differently. And I also want to acknowledge something really important here, that you're going to get some notices in the mail, and they can be dense and confusing, and they might even be scary to look at and really hard to understand. If you receive something in the mail from your state Medicaid program, just try not to set it aside simply because it's confusing or overwhelming. I understand that, but open it. And if you don't understand at that point, that's when you can ask for help. But don't just leave your mail sitting unopened, because I know nobody has ever opened an insurance envelope and thought, "Oh my gosh, what a delightful surprise." 

But this is one of those pieces of mail that we just don't want slowly becoming part of your pile on the corner that you don't think about. Guilty, guilty as charged right here. If you do think that an exclusion or an exemption might apply to you, find out what documentation your state requires. Don't just assume that the system will automatically have every piece of information that it needs. Nick, I get one of these letters in my mailbox. I genuinely have no idea what it means, and it looks really scary, and I don't even know what to do, and I'm completely overwhelmed. Where do I even start once I open it? 

Nick Turkas: I would look for that phone number on the paper that will typically say, "If you have questions, call." If you have a member number or a user number, right? You want to have that handy, and call in. And then ask specifically, "I got this in the mail. I want to verify what this means and what I need to do next." Right? And asking those questions and documenting that you did ask is… You're going to get a much straighter answer from a human. And also, your circumstances from the time that letter was mailed to the point in time it is right now may have changed. You just need to double check where you are in your status with your health insurance. 

Alisa Casavant: Medicaid can be really confusing even if you do have a case manager. Start with your case manager if you have one. That's going to be the person that knows your specific case the best. The headline here is not everybody on Medicaid now has to work 80 hours. The headline is: Find out whether the requirement applies to you and understand if an exclusion or exemption might apply. And then respond and call your state when they ask for information and get it to them. And then, because successfully enrolling insurance apparently wasn't enough, Nick, sometimes you try to actually use your health insurance and the answer is no. My gosh, isn't that crazy? 

So, this came through very clearly from our community. One of the biggest concerns that Kristen had is insurance denying procedures or imaging that her doctor says that she needs. I think that this captures that frustration really, really well, when you and your clinician made a decision that you thought was right for you. It sounds like a good plan, everybody's on board, and suddenly your health insurance company is saying that actually, “No, you need to submit some prior authorization.” Or worse, “I’m going to deny it, and you're going to try again.” So, what happens if that happens, Nick? 

Nick Turkas: You should definitely appeal. You definitely need to first contact the insurer and ask specifically, “Why was this claim denied? And I’d like to have it in writing.” Making that very specific request and then asking for that very specific follow-up of what you need to do to get that care covered. Sometimes it can be because a physician didn't code or write down exactly what you needed in a way that the insurance company interpreted as necessary. And then following up with your provider. 

If your doctor recommended that you get a medication or have a surgery and it was denied, not only do you need to call the insurance company, but you need to let your provider know that it was denied, because they are anticipating that you're getting the care that they recommended, and you're not. And oftentimes they can do things to help you out. And I'd also say, if you don't have time for a lot of phone calls, this is where those apps that most healthcare providers have where there's a messaging system involved, then that would keep you off the hold line a lot less. 

Alisa Casavant: That's such a good tip, Nick. I use the messaging all the time to get through (laughter) to my doctors and speed things up. And, you know, prior authorization or step therapy, all of these topics we've talked about today are Arthritis Foundation advocacy and patient education issues. We are trying very hard to get you the right information and also challenging some of these issues that you're facing. Patients shouldn't have to guess why you were denied care. You shouldn't have to guess what information is missing. And you do have the right to appeal. I think all of these questions build up to why health insurance and access are such important parts of the Arthritis Foundation's work across every area that we work in. 

Nick and I are especially passionate about our mission delivery, our patient education, science, advocacy, the Helpline, you name it. We have a full team of staff here to help support you, and we're all patients ourselves. We all have different conditions and diagnoses, but I think these comments that we've received from you are illustrating why health insurance isn't some separate policy wonky issue for us. Can you get your medication that your clinician prescribed? Can you afford that infusion that you need? Can you get a rheumatologist who's in-network and lives within a reasonable distance from you? And those are all arthritis patient experiences that show us where the system is working and where it isn't. 

We can take a lot of those stories and experiences that you share with us into conversations with policymakers and work on changing some of these rules. We talk with insurance plans. We do a lot on the behind-the-scenes work as staff to help you navigate the system better. And then, Nick, can you share a little bit about some of our patient education resources, or where can people go specifically on the Arthritis Foundation's website or specifically to get in touch with us? 

Nick Turkas: That's right. Calling the Helpline is one of the best ways to get personalized information and referral services. You can call 1-800-283-7800. You can also go and check out some of our webinars. We have in-person patient education events all throughout the country. And we also have a national network of support groups, or what we call Connect Groups. And Connect Groups really connect people with arthritis with each other in community and virtually. And often learning from other people just like you is the best way to learn about your condition and about how to access healthcare. 

PROMO: The Arthritis Foundation’s website is packed with helpful information about various types of arthritis and how to manage them. You can find inspiring stories from people living with arthritis every day, as well as opportunities to connect with others through support groups and community events. Get resources on physical activity with arthritis, nutrition tips that support joint health and so much more. Check us out at arthritis.org. 

Alisa Casavant: If you're listening and thinking, "Okay, great. Thanks, Alisa and Nick. I still have questions." And we have people for that. The Arthritis Foundation Helpline can help you connect with that information. The number is 800-283-7800. They are open Monday through Friday, 9 to 5 Eastern, or you can visit the Helpline website. We're going to drop everything in the show notes, but there is an online form you can fill out. And we also have a web chat, too. So, Nick, final takeaways. We've talked about Medicare, Medicaid, Marketplace, insurers, employer coverage, a lot of the different jargon and acronyms. It's a lot for anybody. (laughs) So, let's bring it home. Top three things. What do people need to remember? 

Nick Turkas: You really need to compare plans based on the care that you actually use and what your out-of-pocket cost will actually be. And just make sure that the doctors, the medications and the pharmacies that you all depend on are going to be on that network list. 

Alisa Casavant: The second one I want you to remember is to review your coverage every single year, even if you plan to keep the same plan, because your doctors, meds, costs and insurance requirements can all change. And finally, you don't have to figure it all out by yourself. These systems are really complicated. If something doesn't make sense, it doesn't mean you fail to understand the insurance correctly. Read your notices, ask the questions, use these trusted resources and get help before a deadline passes. 

Remember, your goal is not to earn an honorary degree in health insurance, truly, I promise. Nobody asked for that degree except maybe me. (laughs) But the goal is to make sure that your coverage works for the care that you need. So, Nick, thank you so much for joining me to talk about this today and, importantly, for making health insurance maybe slightly a little less intimidating for people. 

Nick Turkas: I hope so. It was a pleasure. And let's get healthy, everyone. 

Alisa Casavant: And thank you all for listening. Open enrollment, still not fun, but hopefully a little more understandable for you. So, we'll take the win, and we would love to hear from you about our podcast. If you have any thoughts or suggestions to share, please email us at [email protected]. Thanks everybody. 

PODCAST CLOSE: Thank you for listening to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. Get show notes and other episode details at arthritis.org/podcast. Review, rate and recommend us wherever you get your podcasts, on Apple, Spotify and other platforms. This podcast and other life-changing Arthritis Foundation programs, resources and services are made possible in part by generous donors like you. Consider making a gift to support our work at arthritis.org/donate. We appreciate you listening. And please join us again!