How to read it
Your premium starts on the left. It passes through whoever buys the plan — an employer, a broker, or the marketplace — into the pool, where an insurer (and the reinsurer behind it) holds it. From there it’s routed: a PBM decides which drugs and at what price, a network decides which doctors count, a clearinghouse codes every bill. Only then does it reach a pharmacy, a hospital or a lab — and, finally, a doctor.
Each hand is paid out of the same dollar. Above them, three rule-makers decide what any of them is allowed to do for you. Below them, four new hands arrived in 2025–26, mostly built around the tax break rather than around you.
Why we drew it
Everyone sells a piece. Nobody sells the whole thing. No one in the US sells a healthy 26-year-old catastrophe cover priced for their real risk, routine care without paying twice, and credit for the $1–3k a year they already spend on staying healthy. Every piece exists. The bundle doesn’t.
Counting the hands is how we found where a new one could sit — on the member’s side of the table.