Medicare lost its $9.8B safety net. Now what?

Good afternoon. Today's issue is about the gap between what people expect the system to cover and what it actually does, and how expensive that gap gets when you find out too late.

On The Money Today:

Let's get into it.

U.S. healthcare spending has grown six-fold since 2000, from $1.4 trillion to $5.6 trillion in 2025, with $8.6 trillion projected by 2033. That growth is the backdrop for our first story: the more money moves through the system, the harder insurers push back on individual claims.

Americans spent $5.6 trillion on health care in 2025, and that number could reach $8.6 trillion by 2033. For some patients, the biggest financial burden comes after their claim is denied.

That's what happened to 26-year-old Payton Herres, a heart transplant survivor left without coverage for a critical drug until viral posts and attention from billionaire Mark Cuban got her affordable access.

Ghost approval

Herres had a heart transplant as a preteen. A year later she began taking everolimus, a generic version of Novartis's anti-rejection drug Zortress, off-label. Last year, Elevance Health told her it would no longer cover it.

So she took to Facebook. Her post was shared thousands of times and her coverage was restored a day later — at $1,000 per 90-day supply, up from the $180 she used to pay.

"I call that ghost approval. Technically, you approved it," Herres told MarketWatch. "But I still can't realistically get the med because you [made] it financially impossible to get."

The story went viral again after The Independent covered Mary Cutter, whose 24-year-old son died in 2012 and whose heart was donated to Herres. A post tagging Cuban followed. "Approve and pay for the heart transplant. Deny the generic rejection medicine," he wrote. His pharmacy now supplies the drug for about $300 per 90 days.

What to do if you're rejected

You have the right to appeal. Ask your insurer to review the decision, and if that fails, request an external review from a third party.

Appeals take time, though, and medical bills are a leading cause of bankruptcy for Americans. A Wealthfront Cash Account offers a base APY of 3.30% through program banks, and new clients get an extra 0.75% for their first three months on up to $150,000 — a total variable APY of 4.05%, or 10 times the national deposit savings rate, according to the FDIC's July report. There are no minimums or account fees, and balances are eligible for up to $8M in FDIC insurance through program banks.

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Herres got her drug back because strangers online made enough noise to reach a billionaire — not because the appeals process worked. Most patients don't get a Mark Cuban. What they get is whatever they set aside beforehand.

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Most retirees assume today's tax brackets are locked in for good, especially now that the One Big Beautiful Bill made them "permanent." But permanent only means there's no expiration date, not that a future Congress can't change the numbers.

If you're weighing a Roth conversion or any strategy that depends on today's brackets, waiting could mean converting the same dollars later at a worse rate, with no way to undo it. The retirees coming out ahead are the ones locking in today's math before that changes.

Why it matters: The senior tax deduction many retirees are using to lower this year's bill also expires in 2028, the same year this window closes.

For two years, a federal program kept a lid on what standalone Part D drug plans could charge. That program just ended, and insurers are now free to set their own prices.

The extent of the hit won't show up until your Annual Notice of Change arrives this fall, but there are ways to get ahead of it before your plan resets for 2027.

Why it matters: Without the subsidy, government estimates show monthly premiums could have jumped from about $43 to $81, the exact gap insurers can now pass on to you.

The answer is: B) 1 in 3. According to a 2026 West Health-Gallup survey, roughly a third of American adults said they delayed or skipped medical care in the past year because they couldn't afford it, even though most of them had insurance. The number climbs even higher among people managing a chronic condition, where cost becomes a recurring decision, not a one-time one.