About our sources
We want you to be able to check what we say. Every lesson lists its sources and shows how far each has been checked.
How we choose sources
- We start with official rules: the IRS, CMS (Medicare, Medicaid, and HealthCare.gov), the U.S. Department of Labor, and state agencies.
- We label independent analysis, like KFF reports, as analysis, and explain what each number covers.
- We do not use advertising-driven health sites as evidence, and we write our own explanations.
- For yearly limits, we check the year each number applies to. We do not reuse an old year's number as current.
Source list
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Rev. Proc. 2026-24 (2027 HSA, HDHP, excepted-benefit HRA and DPCSA amounts)
Scope: Federal; HSAs for calendar year 2027
Supports:
- 2027 HSA limit: $4,500 self-only, $9,000 family
- 2027 HDHP minimum deductible: $1,750 self-only, $3,500 family
- 2027 HDHP out-of-pocket maximum: $8,700 self-only, $17,400 family
- 2027 excepted-benefit HRA maximum: $2,250
- Direct primary care arrangements up to $150/$300 per month do not disqualify HSA eligibility (effective 2026)
Used in: HSA, FSA, and HRA, How much to put in
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Rev. Proc. 2025-19 (2026 HSA, HDHP and excepted-benefit HRA amounts)
Scope: Federal; HSAs for calendar year 2026
Supports:
- 2026 HSA limit: $4,400 self-only, $8,750 family
- 2026 HDHP minimum deductible: $1,700 self-only, $3,400 family
- 2026 HDHP out-of-pocket maximum: $8,500 self-only, $17,000 family
Used in: Deductible, copay, and more, HSA, FSA, and HRA, How much to put in
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Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
Scope: Federal tax rules for HSAs, health FSAs and HRAs
Supports:
- HSA contribution limit is zero beginning with the first month of Medicare enrollment, including retroactive coverage
- Last-month rule and testing period
- Age 55+ additional (catch-up) contribution of $1,000
- Employer contributions count toward the HSA limit
- Health FSA plans may offer either a carryover or a grace period, not both
- Limited-purpose health FSAs and HRAs can be compatible with HSA eligibility
- HSA qualified medical expenses include those of you, your spouse, and your tax dependents (plus certain people you could have claimed), even if they are not covered by your HDHP
- Health FSA expenses can include your child under age 27 at the end of your tax year, even if not your dependent
- A health FSA cannot reimburse insurance premiums, long-term care, or amounts covered under another plan
- Over-the-counter medicines (with or without a prescription) and menstrual care products are medical care for HSAs and FSAs
Used in: HSA, FSA, and HRA, How much to put in
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Message Board: 2026 FSA contribution limits
Scope: Federal FSA limits as stated for the FSAFEDS program; figures match IRS Rev. Proc. 2025-32 as summarized elsewhere
Supports:
- 2026 health FSA and limited-expense FSA limit: $3,400
- Maximum carryover of unused 2026 funds into 2027: $680
- 2026 dependent care FSA limit: $7,500 per household ($3,750 married filing separately)
Used in: HSA, FSA, and HRA, How much to put in
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Rev. Proc. 2025-32 (2026 inflation adjustments, including health FSA limit)
Scope: Federal; health FSA salary-reduction limit for plan years beginning in 2026
Supports:
- Issuing document for the 2026 health FSA limit ($3,400) and carryover ($680); figures confirmed only through FSAFEDS and a Gallagher summary during this run
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Notice 2026-5: HSA changes under Public Law 119-21
Scope: Federal; HSA eligibility with bronze and catastrophic Marketplace plans, telehealth, direct primary care
Supports:
- Bronze and catastrophic Marketplace plans may be treated as HSA-qualifying for months after December 31, 2025
- Telehealth safe harbor made permanent for plan years beginning after December 31, 2024
Used in: HSA, FSA, and HRA
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Publication 502 (2025), Medical and Dental Expenses
Scope: Federal itemized medical-expense deduction; also used as a general guide to medical expenses
Supports:
- Itemized-deduction rules differ from HSA/FSA reimbursement rules
- Includes acupuncture, chiropractor, psychologist and psychiatric care, hearing aids and batteries, eyeglasses, contact lenses and laser eye surgery, breast pumps, fertility enhancement including IVF and temporary egg/sperm storage, birth control pills, vasectomy and sterilization, and stop-smoking programs
- Weight-loss programs count for a specific disease diagnosed by a physician; gym dues do not
- Lodging away from home for care up to $50 per night per person, $100 for a parent with a sick child; meals not included
- Capital home improvements count only to the extent the cost exceeds the increase in property value
- Guide dogs and other service animals, including food, grooming and veterinary care
- Special education or tutoring for a learning disability on a doctor's recommendation
- Lead-based paint removal for a child who has or had lead poisoning
- A wig advised by a doctor after hair loss from disease
- Medical conferences about a chronic illness of you, your spouse or a dependent (admission and transportation, not meals or lodging)
- Nursing services, including by someone who is not a nurse
- Teeth whitening, general-health vitamins and nonprescription nicotine gum and patches are not deductible
Used in: How much to put in
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Submit a complaint (No Surprises Help Desk)
Scope: Federal surprise-billing and good faith estimate protections
Supports:
- No Surprises Help Desk: 1-800-985-3059, in English, Spanish and over 350 other languages
- CMS reviews compliance with surprise-billing rules and may refer complaints to other federal or state authorities
- Have the bill, insurance card, EOB, and if available the good faith estimate, notice and consent form, and correspondence
- Keep the confirmation number; CMS may contact you within 60 days if it needs more information
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Ask EBSA
Scope: Private employer-based health and retirement plans
Supports:
- EBSA Benefits Advisors can be reached at 1-866-444-3272
- Questions and complaints about health plans can be submitted online to a Benefits Advisor
Used in: Find your plan's rules
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Know your medical bill rights when not using insurance
Scope: Good faith estimates for people uninsured or not using insurance
Supports:
- Usually providers must give a good faith estimate when you schedule care at least 3 business days ahead, or when you ask
- Applies when you have no insurance or choose not to use it; no estimate during emergency care
- An estimate covers one provider or facility, so ask each provider and the facility for their own
- You do not need to use the words "good faith" to ask; get it in writing and keep a copy
Used in: Before an appointment
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Dispute a medical bill (patient-provider dispute resolution)
Scope: Federal dispute process for self-pay bills above a good faith estimate
Supports:
- Eligible if a provider or facility billed at least $400 more than its good faith estimate, for self-pay care on or after January 1, 2022
- Start within 120 calendar days of the initial bill; needs the estimate, the bill and a $25 non-refundable fee
- An independent reviewer decides the amount; disputing cannot increase your costs
- During the dispute the provider cannot send the bill to collections, collect late fees, or retaliate
- If you used insurance you cannot use this process; submit a complaint or appeal instead
Used in: Before an appointment
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How to File a Complaint
Scope: California complaints and Independent Medical Review for DMHC-regulated health plans
Supports:
- File a grievance with your health plan and take part for 30 days before filing with the DMHC, unless there is a serious threat to your life or the request was denied as experimental
- Consumer complaints can cover billing problems, claim and copay disputes, cancellations and access to care
- Help line 1-888-466-2219
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Health Care Providers Guide To The Complaint Process
Scope: Which California regulator oversees which type of health plan
Supports:
- Most California health plans are regulated by either the CDI or the DMHC
- CDI regulates point-of-service plans and certain PPOs underwritten by CDI-licensed insurers; DMHC regulates HMOs and certain Knox-Keene PPOs
- CDI does not regulate self-insured plans, even when an insurance company administers them
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Hospital Bill Complaint Program
Scope: California complaints about hospital financial assistance and debt collection
Supports:
- Investigates complaints about hospital financial assistance and debt collection policies, notices and website requirements under the Hospital Fair Pricing Act, from January 1, 2024
- You may file if you believe you were wrongly denied financial assistance
- No authority over general billing or fee disputes, price transparency, good faith estimates, or emergency room provider billing other than facility charges
- Uninsured patients or those with high medical costs with family income up to 400 percent of the federal poverty level can apply for discount payment or charity care
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Filing a Claim for Your Health Benefits
Scope: Private employer plans covered by ERISA
Supports:
- At least 180 days to request a review of a denied claim
- Urgent care claims and appeals decided within 72 hours
- Pre-service decisions within 15 days; pre-service appeals within 30 days; post-service decisions within 30 days
- Denial notice must explain why and how to appeal
Used in: Why was my claim denied?, Prepare an appeal, Prior authorization, Find your plan's rules
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Internal appeals
Scope: Most non-grandfathered individual and employer plans
Supports:
- File an internal appeal within 180 days of the denial notice
- In urgent situations you can ask for external review at the same time as an internal appeal
- The final decision must explain how to request external review
Used in: Why was my claim denied?, Prepare an appeal, Prior authorization, Who can help
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External review
Scope: Most non-grandfathered plans
Supports:
- How independent external review works and filing deadlines
Used in: Prepare an appeal
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Medical bill rights (No Surprises Act protections)
Scope: Federal surprise-billing protections and good faith estimates
Supports:
- Protection from surprise bills for most emergency care and some out-of-network care at in-network facilities
- Right to a good faith estimate when uninsured or not using insurance
Used in: Bill or EOB?, Before an appointment, When a bill is hard to afford
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Claims Denials and Appeals in ACA Marketplace Plans in 2024
Scope: Insurers selling qualified health plans on HealthCare.gov; claims, not patients
Supports:
- 19% of in-network claims denied in 2024; 37% of out-of-network; about 20% overall
- About 496 million claims reported; 157 reporting insurers
- In-network denial rates ranged from 3% to 36% by insurer
- Claims denied, resubmitted and later paid are not counted as denied
- Consumers rarely appeal denied claims
Used in: Why was my claim denied?
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Transparency in Coverage public use files
Scope: Underlying data for KFF Marketplace denial analysis
Supports:
- Underlying claims and denial counts reported by HealthCare.gov insurers
Used in: Why was my claim denied?
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What should I know about debt collection and credit reporting if my medical bill was sent to collections?
Scope: Federal; FDCPA debt collectors and FCRA furnishers/credit bureaus
Supports:
- Dispute a debt you believe exceeds what the No Surprises Act allows in writing to the collector as soon as possible
- Credit bureaus must follow reasonable procedures to assure maximum possible accuracy and meet dispute obligations
Used in: When a bill is hard to afford
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Prohibition on Creditors and Consumer Reporting Agencies Concerning Medical Information (Regulation V): status notice
Scope: Federal; does not address state medical-debt reporting laws
Supports:
- On July 11, 2025 the U.S. District Court for the Eastern District of Texas vacated the January 2025 medical-debt credit-reporting rule (Cornerstone Credit Union League v. CFPB)
Used in: When a bill is hard to afford
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Can I apply for debt relief?
Scope: One nonprofit; does not describe other debt-relief organizations
Supports:
- Undue Medical Debt cannot relieve debt by individual request; it buys bundled portfolios that providers are willing to sell
Used in: When a bill is hard to afford
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Financial assistance policies (FAPs)
Scope: Federal; tax-exempt 501(c)(3) hospital facilities only
Supports:
- Tax-exempt hospital facilities must have a written financial assistance policy covering emergency and medically necessary care
- Hospitals must widely publicize the FAP, including notice on billing statements and a plain-language summary at intake or discharge
- FAP documents must be translated for limited-English groups of the lesser of 1,000 people or 5% of the community
Used in: When a bill is hard to afford, Applying for financial assistance
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Medicare.gov
Scope: Medicare coverage, plan documents, appeals and SHIP counseling
Supports:
- Where Medicare rules, plan documents and free counseling are found
Used in: Prepare an appeal, Find your plan's rules, Who can help, Medicare basics
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Parts of Medicare
Scope: Federal; Medicare Parts A, B, C and D, Medigap, Original Medicare and Medicare Advantage
Supports:
- Part A covers inpatient hospital, skilled nursing facility, hospice and some home health care
- Part B covers doctor services, outpatient care, durable medical equipment and many preventive services
- Part D drug coverage is offered by private plans that follow Medicare rules
- Medicare Advantage (Part C) plans may require network doctors and prior authorization, and have a yearly out-of-pocket limit
- Medigap policies are standardized and named by letters in most states
Used in: Medicare basics
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When does Medicare coverage start?
Scope: Federal; Medicare sign-up periods and late enrollment penalties
Supports:
- Initial Enrollment Period lasts 7 months: 3 months before, the month of, and 3 months after turning 65
- Missing it can mean a monthly Part B late enrollment penalty for as long as you have Part B
- General Enrollment Period runs January 1 to March 31; coverage starts the month after sign-up
- People who lost Medicaid coverage have a Special Enrollment Period ending 6 months after Medicaid ends
Used in: Medicare basics, Medicaid and CHIP
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Changes Coming to Medicaid in Pennsylvania
Scope: One state agency summary of federal Medicaid changes under H.R. 1; details and dates can differ by state
Supports:
- Starting January 1, 2027, retroactive Medicaid coverage is shorter than the current up to three months
- Starting January 1, 2027, some adults ages 19 to 64 in the expansion group must show they meet work requirements; some people are exempt
- Some adults ages 19 to 64 will renew Medicaid every six months instead of every year
Used in: Medicaid and CHIP
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Medicaid.gov
Scope: Medicaid and CHIP; rules vary by state
Supports:
- Medicaid and CHIP are run by states within federal rules
Used in: Find your plan's rules, Medicaid and CHIP
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Summary of Benefits and Coverage
Scope: Plan summaries for most individual and employer plans
Supports:
- Most plans must provide a standard Summary of Benefits and Coverage
Used in: Bill or EOB?, Deductible, copay, and more, Before an appointment, Vision, dental, and prescriptions, Find your plan's rules
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California treatment of health savings accounts
Scope: California state income tax
Supports:
- California does not follow the federal tax exclusion for HSA contributions and earnings
Used in: HSA, FSA, and HRA
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Financial assistance policy and emergency medical care policy (Section 501(r)(4))
Scope: Nonprofit (tax-exempt) hospitals
Supports:
- Nonprofit hospitals must have a written financial assistance policy
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Interoperability and Prior Authorization Final Rule (CMS-0057-F)
Scope: Medicare Advantage, Medicaid, CHIP and Marketplace plans on HealthCare.gov
Supports:
- Prior authorization decision timeframes for certain plans beginning in 2026
Used in: Prior authorization
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AMME Health
Scope: Company information; AMME Navigator private beta
Supports:
- AMME Navigator is in private beta and people can express interest on amme.health
Used in: Who can help
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Billing and collections (Section 501(r)(6))
Scope: Federal; tax-exempt 501(c)(3) hospital facilities only
Supports:
- The application period ends 240 days after the first post-discharge billing statement; the notification period is 120 days
- Before extraordinary collection actions the hospital must give written notice at least 30 days ahead with a plain-language summary and make a reasonable effort at oral notice
- After a complete application, the hospital may not start or resume extraordinary collection actions until it decides eligibility
- If eligible, the hospital must refund overpayments (unless under $5) and reverse collection actions, including credit-report information
- Deferring or denying medically necessary care because of past unpaid bills is an extraordinary collection action
Used in: Applying for financial assistance
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Help with drug costs (Extra Help)
Scope: Medicare drug coverage (Part D); not available in the U.S. territories
Supports:
- People with full Medicaid, a Medicare Savings Program or SSI get Extra Help automatically; others apply through Social Security
- 2026 limits: income $23,940 and resources $18,090 for an individual; $32,460 and $36,100 for a married couple
- In 2027 Extra Help means $0 premium and deductible, up to $5.80 per generic and $14.40 per brand-name drug
- No Part D late enrollment penalty while getting Extra Help; people can reapply at any time
Used in: Paying for prescriptions
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Medicare Prescription Payment Plan
Scope: People with Medicare drug coverage (Part D or Medicare Advantage with drug coverage)
Supports:
- Spreads drug costs into monthly bills from the plan; it does not lower drug costs
- Out-of-pocket drug costs are capped at $2,100 in 2026 for everyone with Medicare drug coverage
- May not be the best choice with low or steady costs, sign-up late in the year, or with Extra Help
Used in: Paying for prescriptions
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Special Advisory Bulletin: Pharmaceutical Manufacturer Copayment Coupons
Scope: Drugs paid for by federal health care programs, including Medicare Part D
Supports:
- Manufacturer copay coupons used for drugs paid by federal programs such as Medicare Part D implicate the federal anti-kickback statute
- Coupons typically state that people in federal health care programs may not use them
- Manufacturers may donate to independent charities that help patients regardless of the medicine they take
Used in: Paying for prescriptions
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BeSafeRx: Your source for online pharmacy information
Scope: Buying medicine online in the United States
Supports:
- Use a state-licensed online pharmacy; FDA helps people check pharmacies and report unlawful sellers
Used in: Paying for prescriptions
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Donating Through Crowdfunding and Fundraising Platforms
Scope: Federal consumer advice; written mainly for donors
Supports:
- Each crowdfunding platform has its own rules; find out the fees and when the platform pays out
- Money raised goes to the campaign organizer, who controls how it is spent
- Donations to individuals are not tax deductible
- Scammers often use stolen photos and copy and paste other people's stories; a reverse image search can reveal reused photos
- The safest way to give is to campaigns organized by people you know and trust
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GoFundMe pricing
Scope: One company; U.S. personal fundraisers. Other platforms charge differently
Supports:
- No fee to start or manage a fundraiser
- One transaction fee of 2.9% + $0.30 per donation, deducted automatically
- Donor contributions (tips) to GoFundMe are optional
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Start a medical fundraiser on GoFundMe
Scope: One company's own advice to people raising money for medical costs
Supports:
- Ask the person you are fundraising for whether they are comfortable with you starting the fundraiser
- The organizer can invite the person being helped to set up bank transfers so they receive the money directly
- Sharing what the money is for, even estimates of costs, helps donors understand the need
- The goal can be raised or lowered at any time
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Common Fundraising Questions
Scope: One company's help page
Supports:
- Reaching the goal is not required; the organizer keeps each donation received
- A fundraiser can keep accepting donations after the goal is reached
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GoFundMe Terms of Service
Scope: One company's contract terms
Supports:
- If a beneficiary does not complete the steps to withdraw funds within 120 days of the first donation, GoFundMe may refund donors or redirect funds to an aligned nonprofit
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IRS reminds taxpayers of important tax guidelines involving contributions and distributions from online crowdfunding (FS-2024-28)
Scope: Federal income tax only; state rules may differ
Supports:
- Whether crowdfunding money is taxable depends on all the facts and circumstances
- Contributions given out of detached and disinterested generosity, with nothing expected in return, may be gifts that are not taxable to the person helped
- Contributions from an employer to, or for, an employee are generally taxable to the employee
- A Form 1099-K does not automatically mean the amount is taxable
- Organizers and recipients should keep complete records for at least three years
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Understanding Supplemental Security Income: SSI income
Scope: Federal SSI only; Medicaid rules are set by each state
Supports:
- Cash from friends and relatives is unearned income for SSI
- Generally, the more countable income you have, the less your SSI benefit will be
- Money someone else spends to pay your expenses for items other than food or shelter (for example, medical bills) does not count as income