E.Goodwin Insurance Agency

Health Insurance Needs More Competition
When we look at the health insurance landscape, it's clear that true competition is lacking. Recent research found that, on average, one insurer controls about 64% of a state's market—with the top three commanding around 91%. This high level of concentration naturally raises concerns about whether coverage options are as competitive as they should be for consumers. Limited competition, combined with adverse selection, often leads to insurers favoring healthier applicants, making it challenging to maintain stable, customer-focused markets across the country. While new entrants sometimes attract early interest with lower premiums, their smaller size can mean weaker negotiating power with providers and higher expenses—ultimately threatening their ability to stick around. In these concentrated markets, we've seen insurance plans offer perks that appeal to healthier individuals or create extra hurdles, like higher copays and more paperwork, for those who need costly care. The path forward, as proposed by researchers, involves broader oversight: policymakers could revisit market rules to foster real competition for customers, all while ensuring protections for those with preexisting conditions remain intact. As someone who has committed my career to helping Ohio families navigate their insurance choices, I believe in solutions that keep coverage both accessible and fair.

Who Covers GLP-1 Drugs for Weight Loss?
GLP-1 medications—often discussed for weight loss—can be tricky when it comes to insurance coverage. In the US, most health plans do cover these drugs for diabetes or related conditions, but if you’re seeking them solely for weight management, coverage is much less consistent. Policies vary: many plans require prior authorization and set minimum BMI thresholds before approving weight management prescriptions. On the individual market, weight-loss coverage is rare. Employer-sponsored plans are mixed—about 60% cover GLP-1s for diabetes, but only around 35% also cover them for weight loss. For seniors, the standard federal drug benefit still excludes weight-loss-only use, though a recent pilot project offers certain GLP-1s for $50 a month. Since state and federal rules can differ, it’s always wise to review your plan’s details, consider an appeal if you’re denied, and keep an eye out for future updates. At eGoodwin Insurance Agency, I help clients untangle these details so they can make informed decisions about their health coverage.

US Debate Over Breast Test Coverage
The ongoing debate over national coverage for biomarker tests in breast cancer treatment highlights how medical innovation and insurance policy often collide. DCIS—ductal carcinoma in situ—is a non-invasive breast cancer found in milk ducts, but its behavior can vary significantly, making it tough for physicians to determine who truly benefits from added treatments like radiation. Biomarker tests are designed to bring more clarity by factoring in tumor biology alongside traditional clinical information, helping estimate both the risk of cancer coming back and whether radiation would actually make a difference. Supporters of these tests believe that this added insight helps tailor care—allowing some women to safely skip radiation, while flagging others who could benefit from it. Yet, questions remain at the federal level about whether these tests provide enough extra value to be covered under national insurance. While agencies acknowledge the promise of these innovations, lab tests currently aren’t included in the new accelerated coverage pathway. Another national advisory panel will review the issue on October 13. As someone who helps families navigate insurance choices every day, I see how decisions like these shape both care and coverage for our clients.

US Colonoscopy Coverage Before Age 45
Colonoscopy coverage is something many clients ask about, especially for those under 45. In most cases, insurance plans in the US won't cover a colonoscopy before age 45 unless there are symptoms, a family history, or other risk factors that make it medically necessary. Preventive screenings are federally required to start at 45, so if you're younger and considered average risk, a colonoscopy is possible but would likely mean paying out of pocket. If symptoms do appear, insurance treats the procedure as diagnostic care, and private plans should also cover polyp removal during a screening. For those with a family history, prior polyps, or inflammatory bowel disease, earlier screening might be recommended, and symptoms at any age are always worth discussing with your doctor. Routine screenings can actually help prevent one in three colorectal cancer deaths—a powerful reminder of the value of preventive care. With procedure costs ranging from $1,250 to $4,000 or more without insurance, it's smart to ask about alternatives like stool tests, confirm your network status, understand exactly what's covered, and know your rights if you need to file an appeal. At eGoodwin Insurance Agency, my focus is helping families in central Ohio understand their coverage so they can make informed decisions about their health and financial well-being.

US LPFSA Rules for 2026
As someone who’s helped families across central Ohio navigate their insurance options, I know how valuable it is to stay informed about the benefits your workplace offers. For 2026, the Limited Purpose Flexible Spending Account (LPFSA) is set up as a tax-advantaged way for employees to save for dental and vision costs—think cleanings, fillings, exams, contacts, and glasses—using pretax dollars. Only those whose employers offer LPFSAs can take advantage, with contributions capped at $3,400 for the year, directly lowering your taxable income. Keep in mind, these funds can’t be spent on general medical expenses (that’s what your HSA is for), and most plans follow the use-it-or-lose-it rule. However, some employers let you carry over up to $680 into the next year or give you a 2.5-month grace period to use remaining funds. If you’re looking at your benefits for next year, understanding these details can really help you make the most of your coverage.

US Health Insurance Cost Tradeoffs Ahead
We've seen US uninsured rates reach impressive lows in recent years, but that progress is now facing some headwinds. With the expiration of pandemic-era tax credits at the end of 2025, it's estimated that over 2.5 million fewer people will enroll in marketplace health plans for 2026. Additionally, new work requirements and changes in funding for state-federal health programs are projected to reduce enrollment by around 7.6 million people by 2034. While these changes may help cut federal spending, states are left to navigate a tricky mix of lost federal dollars, shifting coverage costs, and the unique needs of rural communities. Even as some states set annual caps on health cost growth, the impact on premiums and hospital prices has been minimal—largely due to limited enforcement options. One approach that could offer real relief is simplifying insurance administration, potentially lowering costs without sacrificing quality, though this might also mean fewer plan options. As someone who helps clients every day with their insurance decisions here in central Ohio, I know how important it is to stay informed about these shifts. Understanding the broader landscape helps all of us make the best choices for our families and communities.