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- 我們以官方規定為起點：美國國稅局（IRS）、CMS（聯邦醫療保險、聯邦醫療補助和 HealthCare.gov）、美國勞工部，以及各州政府機構。
- 我們把獨立分析（例如 KFF 的報告）標註為分析，並說明每個數字涵蓋的範圍。
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- 對於年度上限，我們會核對每個數字適用的年份。我們不會把舊年份的數字當作當前數字使用。
資料來源列表
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Rev. Proc. 2026-24 (2027 HSA, HDHP, excepted-benefit HRA and DPCSA amounts)
範圍: Federal; HSAs for calendar year 2027
支援的內容:
- 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)
用於: HSA、FSA 和 HRA, 存多少錢
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Rev. Proc. 2025-19 (2026 HSA, HDHP and excepted-benefit HRA amounts)
範圍: Federal; HSAs for calendar year 2026
支援的內容:
- 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
用於: 自付額、定額手續費等, HSA、FSA 和 HRA, 存多少錢
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Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
範圍: Federal tax rules for HSAs, health FSAs and HRAs
支援的內容:
- 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
用於: HSA、FSA 和 HRA, 存多少錢
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Message Board: 2026 FSA contribution limits
範圍: Federal FSA limits as stated for the FSAFEDS program; figures match IRS Rev. Proc. 2025-32 as summarized elsewhere
支援的內容:
- 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)
用於: HSA、FSA 和 HRA, 存多少錢
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Rev. Proc. 2025-32 (2026 inflation adjustments, including health FSA limit)
範圍: Federal; health FSA salary-reduction limit for plan years beginning in 2026
支援的內容:
- 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
範圍: Federal; HSA eligibility with bronze and catastrophic Marketplace plans, telehealth, direct primary care
支援的內容:
- 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
用於: HSA、FSA 和 HRA
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Publication 502 (2025), Medical and Dental Expenses
範圍: Federal itemized medical-expense deduction; also used as a general guide to medical expenses
支援的內容:
- 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
用於: 存多少錢
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Submit a complaint (No Surprises Help Desk)
範圍: Federal surprise-billing and good faith estimate protections
支援的內容:
- 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
範圍: Private employer-based health and retirement plans
支援的內容:
- 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
用於: 查詢您計劃的規則
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Know your medical bill rights when not using insurance
範圍: Good faith estimates for people uninsured or not using insurance
支援的內容:
- 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
用於: 就診之前
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Dispute a medical bill (patient-provider dispute resolution)
範圍: Federal dispute process for self-pay bills above a good faith estimate
支援的內容:
- 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
用於: 就診之前
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How to File a Complaint
範圍: California complaints and Independent Medical Review for DMHC-regulated health plans
支援的內容:
- 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
範圍: Which California regulator oversees which type of health plan
支援的內容:
- 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
範圍: California complaints about hospital financial assistance and debt collection
支援的內容:
- 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
範圍: Private employer plans covered by ERISA
支援的內容:
- 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
用於: 理賠申請為什麼被拒？, 準備申訴, 事先授權, 查詢您計劃的規則
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Internal appeals
範圍: Most non-grandfathered individual and employer plans
支援的內容:
- 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
用於: 理賠申請為什麼被拒？, 準備申訴, 事先授權, 誰可以幫忙
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External review
範圍: Most non-grandfathered plans
支援的內容:
- How independent external review works and filing deadlines
用於: 準備申訴
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Medical bill rights (No Surprises Act protections)
範圍: Federal surprise-billing protections and good faith estimates
支援的內容:
- 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
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Claims Denials and Appeals in ACA Marketplace Plans in 2024
範圍: Insurers selling qualified health plans on HealthCare.gov; claims, not patients
支援的內容:
- 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
用於: 理賠申請為什麼被拒？
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Transparency in Coverage public use files
範圍: Underlying data for KFF Marketplace denial analysis
支援的內容:
- Underlying claims and denial counts reported by HealthCare.gov insurers
用於: 理賠申請為什麼被拒？
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What should I know about debt collection and credit reporting if my medical bill was sent to collections?
範圍: Federal; FDCPA debt collectors and FCRA furnishers/credit bureaus
支援的內容:
- 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
用於: 賬單難以負擔時
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Prohibition on Creditors and Consumer Reporting Agencies Concerning Medical Information (Regulation V): status notice
範圍: Federal; does not address state medical-debt reporting laws
支援的內容:
- 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)
用於: 賬單難以負擔時
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Can I apply for debt relief?
範圍: One nonprofit; does not describe other debt-relief organizations
支援的內容:
- Undue Medical Debt cannot relieve debt by individual request; it buys bundled portfolios that providers are willing to sell
用於: 賬單難以負擔時
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Financial assistance policies (FAPs)
範圍: Federal; tax-exempt 501(c)(3) hospital facilities only
支援的內容:
- 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
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Medicare.gov
範圍: Medicare coverage, plan documents, appeals and SHIP counseling
支援的內容:
- Where Medicare rules, plan documents and free counseling are found
用於: 準備申訴, 查詢您計劃的規則, 誰可以幫忙, Medicare 基礎知識
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Parts of Medicare
範圍: Federal; Medicare Parts A, B, C and D, Medigap, Original Medicare and Medicare Advantage
支援的內容:
- 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
用於: Medicare 基礎知識
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When does Medicare coverage start?
範圍: Federal; Medicare sign-up periods and late enrollment penalties
支援的內容:
- 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
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Changes Coming to Medicaid in Pennsylvania
範圍: One state agency summary of federal Medicaid changes under H.R. 1; details and dates can differ by state
支援的內容:
- 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
用於: Medicaid 和 CHIP
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Medicaid.gov
範圍: Medicaid and CHIP; rules vary by state
支援的內容:
- Medicaid and CHIP are run by states within federal rules
用於: 查詢您計劃的規則, Medicaid 和 CHIP
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Summary of Benefits and Coverage
範圍: Plan summaries for most individual and employer plans
支援的內容:
- Most plans must provide a standard Summary of Benefits and Coverage
用於: 賬單還是 EOB？, 自付額、定額手續費等, 就診之前, 眼科、牙科和處方藥, 查詢您計劃的規則
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California treatment of health savings accounts
範圍: California state income tax
支援的內容:
- California does not follow the federal tax exclusion for HSA contributions and earnings
用於: HSA、FSA 和 HRA
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Financial assistance policy and emergency medical care policy (Section 501(r)(4))
範圍: Nonprofit (tax-exempt) hospitals
支援的內容:
- Nonprofit hospitals must have a written financial assistance policy
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Interoperability and Prior Authorization Final Rule (CMS-0057-F)
範圍: Medicare Advantage, Medicaid, CHIP and Marketplace plans on HealthCare.gov
支援的內容:
- Prior authorization decision timeframes for certain plans beginning in 2026
用於: 事先授權
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AMME Health
範圍: Company information; AMME Navigator private beta
支援的內容:
- AMME Navigator is in private beta and people can express interest on amme.health
用於: 誰可以幫忙
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Billing and collections (Section 501(r)(6))
範圍: Federal; tax-exempt 501(c)(3) hospital facilities only
支援的內容:
- 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
用於: 申請經濟援助
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Help with drug costs (Extra Help)
範圍: Medicare drug coverage (Part D); not available in the U.S. territories
支援的內容:
- 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
用於: 支付處方藥費用
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Medicare Prescription Payment Plan
範圍: People with Medicare drug coverage (Part D or Medicare Advantage with drug coverage)
支援的內容:
- 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
用於: 支付處方藥費用
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Special Advisory Bulletin: Pharmaceutical Manufacturer Copayment Coupons
範圍: Drugs paid for by federal health care programs, including Medicare Part D
支援的內容:
- 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
用於: 支付處方藥費用
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BeSafeRx: Your source for online pharmacy information
範圍: Buying medicine online in the United States
支援的內容:
- Use a state-licensed online pharmacy; FDA helps people check pharmacies and report unlawful sellers
用於: 支付處方藥費用
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Donating Through Crowdfunding and Fundraising Platforms
範圍: Federal consumer advice; written mainly for donors
支援的內容:
- 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
範圍: One company; U.S. personal fundraisers. Other platforms charge differently
支援的內容:
- 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
範圍: One company's own advice to people raising money for medical costs
支援的內容:
- 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
範圍: One company's help page
支援的內容:
- 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
範圍: One company's contract terms
支援的內容:
- 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)
範圍: Federal income tax only; state rules may differ
支援的內容:
- 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
範圍: Federal SSI only; Medicaid rules are set by each state
支援的內容:
- 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