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A contractor operates a roller on the construction site of the HS2 Ltd. Old Oak Common super-hub railway station, in view of the Vistry Partnerships regeneration project Oaklands House, in London, U.K., on Wednesday, June 23, 2021.
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Company: Vistry Group (VTY.L)

Business: Vistry Group operates as a housebuilder in the United Kingdom and operates in both the open market and the affordable housing sector. They seek to develop sustainable new homes and communities across all sectors of the U.K. housing market. On Nov. 11, 2022, Vistry acquired Countryside Partnerships for £1.25 billion ($1.4 billion). Vistry operates through a partnership model, which is unique to the U.K., where they seek to reuse land wherever possible, focusing on mixed-tenure developments that deliver positive social impact. The partnerships business operates across 19 business units and works closely with governmental bodies, housing associations and local authorities, as well as selling homes directly to customers on the open market.
Stock market value: $3.09 billion

Activist: Inclusive Capital Partners

Percentage ownership: 5.9%
Average cost: n/a
Activist commentary: Inclusive Capital Partners is a San Francisco-based investment firm focused on increasing shareholder value and promoting sound environmental, social and governance practices. It was formed in 2020 by ValueAct founder Jeff Ubben to leverage capitalism and governance in pursuit of a healthy planet and the health of its inhabitants.
As a pioneering activist ESG investor (AESG), Inclusive seeks long-term shareholder value through active partnership with companies whose core businesses contribute solutions to this pursuit. Their primary focus is on environmental and social value creation, which leads to shareholder value creation.

What’s happening?

On Wednesday, Vistry announced the appointment of Inclusive’s Ubben as a nonexecutive director to the board and the upcoming resignations of two incumbent directors, Katherine Innes Ker and Nigel Keen.

Behind the scenes

Vistry landed on Inclusive’s radar as a result of their engagement with another company – Countryside Partnerships. In May 2022, Inclusive had a 9.2% stake in Countryside and had made two bids to acquire the company, going as high as £1.5 billion. Both bids were rejected.
But Inclusive’s interest sparked significant shareholder pressure to sell Countryside and the following month, the company announced that it was seeking a buyer. On Sept. 5, 2022, Vistry agreed to acquire Countryside in a cash and stock deal, which closed on Nov. 11, 2022.
In the four months since the Countryside acquisition, the market has reacted favorably to the combination. Inclusive led the charge on the merger and now they are taking an active role at the combined company.
Vistry operates through a partnership model whereby the land is provided to them by governmental land authorities at no cost and they commit to build a certain amount of affordable housing. They build communities that are mixed tenure, placing affordable housing among open market homes, retail stores, etc. This model has the benefits of a secular shift to affordable housing and is capex light since they do not have to acquire the land. The company trades cheaply at 7 to 8 times earnings and has high growth prospects, complimented by their community benefits.
Inclusive said Vistry’s business model gives it the scale, operating synergies and resources to deliver societal benefits and great long-term returns.
On Wednesday, Ubben was named a director and two board members, Innes Ker and Keen, resigned. Inclusive is an amicable investor that is often invited onto boards. This situation is no exception. However, the exit of two incumbents alongside Ubben’s appointment indicates that there was a call by shareholders for a bigger board refreshment than just adding one shareholder representative. While this type of action is somewhat unusual for a European company, it is worth noting that the company’s five largest shareholders representing 40% of the stock are all North American investors who are more likely to engage with management than European investors.
This leaves a board that is undergoing a refreshment process and a CEO who is universally well liked and on the same page as shareholders opening the door for a methodology that has worked very well for Ubben going back 20+ years to ValueAct – let a good management team continue to generate cash flow and sit on the board and help advise the best way to use that cash flow.
One tactic he has used successfully in the past to grow shareholder value is to do a share repurchase at the bottom and keep cash when the company is fairly valued.
Finally, as with all Inclusive investments, this one has an impact element as well as a value element. The AESG thesis here is obvious as the core purpose of this company is to further social equality – developing affordable, sustainable housing. What is interesting about this from an ESG perspective is that it is a social ESG thesis, which is generally the most difficult type of ESG thesis to monetize. But, in this case the community benefits align so perfectly with the company growth prospects – topline company growth means more affordable housing.
Ken Squire is the founder and president of 13D Monitor, an institutional research service on shareholder activism, and the founder and portfolio manager of the 13D Activist Fund, a mutual fund that invests in a portfolio of activist 13D investments.

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Three-fourths of Medicare beneficiaries are worried about affording their out-of-pocket costs, compared with 43% who say the same about their premiums, a survey shows.
Basic Medicare (Parts A and B) has no out-of-pocket maximum; nor does Part D (prescription drug coverage) under current law.
Here are some costs that can help you consider how much you may spend, depending on your coverage choices.

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For retirees, health-care costs can be among the most unpredictable expenses they face over the course of their golden years.
While many of them worry about affording their monthly Medicare premiums, their bigger concern is their out-of-pocket costs, according to a recent report from eHealth.

The report says 75% are either “very” or “somewhat” worried about affording those costs, which include deductibles, copays and coinsurance. That compares with 43% who worry about their ability to pay their premiums, according to the report, which is based on a February survey of more than 4,500 Medicare beneficiaries.
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Exactly how much you spend on Medicare depends on both your coverage choices and your use of the health-care system. However, you may be able to pinpoint a worst-case scenario to help you budget.

Beneficiaries have coverage options

Basic, or original, Medicare consists of Part A (hospital coverage) and Part B (outpatient care) and covers 65 million people — 57.3 million are age 65 or older, and the remaining 7.7 million are younger with permanent disabilities.
Many beneficiaries choose to get Parts A and B through an Advantage Plan (Part C), which also typically includes Part D (prescription drug coverage) and often other extras such as dental and vision.

These plans often have no monthly premium or a low one, and they limit how much you pay out of pocket each year for covered services. Deductibles, copays and coinsurance vary from plan to plan.

Other beneficiaries instead decide to pair Parts A and B with a standalone Part D plan and, often, a Medigap plan, which covers part of the out-of-pocket costs that come with Parts A and B. However, premiums can be pricey, depending on where you live and other factors.

Basic Medicare has no out-of-pocket limit

If you have only basic Medicare, there is no cap on what you might spend in any given year.
“With no secondary coverage, there is no out-of-pocket maximum, which leaves a beneficiary financially exposed,” said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans.

How hospital stays are covered

Part A, which comes with no premium for most beneficiaries, has a deductible of $1,600 when you are admitted to the hospital. That covers the first 60 days of inpatient care in a benefit period.
Days 61 through 90 come with coinsurance of $400 per day, and then it’s $800 daily beyond that (so-called lifetime reserve days). And for skilled nursing facilities, a daily coinsurance of $200 kicks in for days 21 through 100.
If you have Medigap, all of those charges are either fully or partially covered under most plans. 

Out-of-pocket maximums may range up to $8,300

Nopphon Pattanasri | Istock | Getty Images

With Advantage Plans, because the cost-sharing differs from plan to plan, “they will all vary but at least their hospital spending would count toward the plan’s out-of-pocket maximum, meaning it would be capped,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits.
In 2023, those maximums can be as much as $8,300 for in-network coverage, Roberts said. 
“In most urban areas, you can find good plans with considerably lower limits,” she said. “If you can find a plan that has a lower out-of-pocket limit, such as $3,000 or $4,000, that is a benefit to you.”

‘The sky is the limit’ on Part B coinsurance with basic Medicare

Part B — which comes with a standard monthly premium of $164.90 in 2023 — has a deductible of $226. But after that, you pay a 20% coinsurance for covered services with no cap on how high that goes.
“It means the sky is the limit on the 20% coinsurance,” Roberts said. “Imagine trying to cover 20% of eight weeks of chemotherapy or for dialysis for the rest of your life or until you get a transplant.”
“In my opinion, this is the most important thing that you want to get covered,” she added. “Both Medigap and Medicare Advantage Plans do a good job of this, since most Medigap plans cover the 20% [coinsurance] and Advantage Plans have caps on Parts A and B spending.”

Part D currently has no out-of-pocket maximum

Under current law, there is no out-of-pocket limit associated with Part D, regardless of whether you get your coverage as a standalone policy or through an Advantage Plan.
A deductible for Part D, which may come with a premium, can be up to $505 in 2023, also regardless of how you get the coverage. 
Part D does come with catastrophic coverage that kicks in once out-of-pocket expenses reach $7,400 in a given year, Roberts said.

After hitting that threshold, “you pay only a small coinsurance or copayment for covered drugs for the rest of the year,” she said.
In 2025, each beneficiary’s annual out-of-pocket spending for Part D will be capped at $2,000.
Also be aware that Medigap plans do not cover any Part D costs.

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Many high school students should be getting their college acceptance letters around this time of the year.
As people weigh which school to attend, making sure they won’t need to borrow too much is key, experts say.

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Families will soon find college acceptance letters in their mailboxes. As students weigh where to attend, making sure they won’t borrow too much is key, experts say.
The consequences of taking on too much student debt can be severe.

“If you borrow too much, you will have less money available for other priorities, such as buying a home,” said higher education expert Mark Kantrowitz. “You may also have to take a job that pays better as opposed to the job that matches your career goals.”
Kantrowitz found in his research that under a third of student loan borrowers who took out $20,000 or less were stressed by their debt, compared with over 60% of those who’d taken out $100,000 or more.
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The general rule of thumb is not to borrow more than you expect to earn as a starting salary, said Betsy Mayotte, president of The Institute of Student Loan Advisors, a nonprofit.
That figure will vary a bit based on what you plan to study. You can look up annual average incomes for different occupations at the U.S. Department of Labor’s website.

Kantrowitz also stands by this metric. “If your total student loan debt at graduation is less than your annual starting salary, you should be able to repay your loans in 10 years or less,” he said.

Kantrowitz recommends families consider colleges based on the “net price,” which is the amount they’ll have to pay with savings, income and loans to cover the bill, after aid that doesn’t need to be repaid, including grants and scholarships, is accounted for.
When calculating the four-year net cost, Kantrowitz said, keep in mind that different years may cost different amounts because some colleges offer grants or scholarships only for the first year or two.
After estimating the total tab, you can figure out — after any savings or income you plan to direct at the college bill — if what you’d need to borrow is reasonable.
“Often, the least expensive option will be an in-state public college,” Kantrowitz said. “They cost a quarter to a third of the cost of a private college but provide just as good a quality of education.”

If students find that all the colleges they applied to would leave them borrowing too much, they can look at others, as many schools still accept applications after May 1, Kantrowitz said. The National Association for College Admission Counseling usually publishes a list of colleges with space still available.
One more point: Incoming college freshmen should more or less tune out news about the Biden administration’s student loan forgiveness plan, experts say.
Even if the program survives the legal challenges it faces, there’s no guarantee there will be another wave of loan cancellation.
“You should only borrow as much as you can reasonably afford to repay,” Kantrowitz said.

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Each of the enrollment periods that occur every year from Jan. 1 through March 31 come with rules to be aware of.
You also may need to enroll in different parts of Medicare that come with their own rules.
Here’s what to know.

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A couple of Medicare enrollment periods are underway — and both end soon.
First, if you didn’t enroll in Medicare when you should have and you don’t qualify for a special enrollment period, you can sign up until March 31. Second, if you are already on Medicare and use an Advantage Plan but don’t think it’s a good match for you — i.e., your doctor is out of network — you can switch to another plan or drop it altogether, also until the end of the month.

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However, each of these opportunities comes with different rules to be aware of, and, possibly, the need to enroll in additional coverage and deal with other deadlines as well. Also, if you miss one of these periods but should have used it, you generally would have to wait for another enrollment window that allows you to get or change coverage.
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Here’s what to know.

1. If you missed your initial enrollment period, sign up now

You become eligible for Medicare at age 65, and you get a seven-month window to sign up. This initial enrollment period starts three months before your birthday month and ends three months after it.
If you missed that window and didn’t have qualifying coverage elsewhere — such as a plan through a large employer — you can sign up for Part A (hospital coverage) and/or Part B (outpatient care coverage) between Jan. 1 and March 31. Signing up during this so-called general enrollment period means coverage starts the month after you enroll; before 2023, the effective date was July 1.

Be aware that depending on how long you’ve gone without Part B coverage, you may face a late-enrollment penalty of 10% for each year you should have been signed up but weren’t. And that penalty, which is tacked on to your premium, is lifelong. 

You also can sign up for an Advantage Plan (Part C) once you’ve applied for Parts A and B during this general enrollment period, but it must be done before your Part B coverage starts. The Advantage Plan may or may not include Part D prescription drug coverage, but most do.
However, if you want a standalone Part D plan to pair with Parts A and B, this general enrollment period is not for that.
“They should consult an agent to see if they qualify for a special enrollment period for Part D, such as losing other creditable coverage in the last 63 days,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits.
If you don’t qualify for a special enrollment period or an exception, you’d generally have to wait until Medicare’s fall annual enrollment period to sign up for a Part D plan.

“If there isn’t a valid special enrollment period that a broker can help you with, it’s still worth a call to 1-800-MEDICARE as they have broader ability to approve unusual special enrollment periods,” Roberts said.
Be aware that Part D also comes with a lifelong late enrollment penalty if you go without qualifying coverage for 63 days or more. That fee is 1% of the national base premium ($32.74 in 2023) for each full month you didn’t have Part D or other acceptable coverage.
Also, individuals who use the general enrollment period can sign up for a Medicare supplemental plan, or “Medigap.”
“The Part B effective date would also initiate a six-month Medigap open enrollment period, if they’d rather go that route,” Roberts said.

2. If your Advantage Plan is not a good fit, change coverage

Separately, but also between Jan. 1 and March 31, Medicare allows Advantage Plan enrollees to switch to another plan or drop it altogether in favor of basic Medicare (Parts A and B). 
Unlike during the annual fall enrollment period when you can change your mind multiple times about your coverage for the following year, you can only make one switch during the current window.
“So if you choose another Medicare Advantage Plan, choose carefully,” Roberts said, adding that you’ll be locked into that coverage choice for the rest of 2023.

If you want to return to basic Medicare instead of having an Advantage Plan, be aware that the move often means losing drug coverage — which means you would have to enroll in a standalone Part D plan.
Additionally, if you drop your Advantage Plan, don’t assume that you’ll be able to get a so-called Medigap policy, which many beneficiaries pair with basic Medicare. These plans either fully or partially cover cost-sharing of some aspects of Parts A and B, including deductibles, copays and coinsurance.
However, they come with their own rules for enrolling. So depending on your state, you may need to pass medical underwriting to get approved for a Medigap policy.
There is an exception to the medical underwriting requirement: If you are within the first year of trying out an Advantage Plan, you generally can return to a Medigap policy without facing underwriting.

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In his new book, “Poverty, by America,” Matthew Desmond says that poverty persists in the U.S. because many Americans and large companies profit from it.
“I want to be clear: I’m not calling for redistribution,” Desmond said. “What I’m talking about is less rich aid and more poor aid.”
The author also has tips on how people can become “poverty abolitionists.”

Over the last 50 years, Americans have eradicated smallpox, reduced infant mortality rates and deaths from heart disease by around 70%, added a decade to the average American’s life and invented the internet.
When it comes to the national poverty rate, however, we’ve made almost no progress. In 1970, a little more than 12% of the U.S. population was considered poor. By 2019, around 11% was.

In his new book, “Poverty, by America,” sociologist Matthew Desmond proposes a reason for that stagnation: We benefit from it.
I spoke with Desmond this month about his argument that many individuals and large U.S. companies profit from tens of millions of Americans living in poverty, and how things might finally start changing.
His last book, “Evicted: Poverty and Profit in the American City,” won the 2017 Pulitzer Prize for general nonfiction. (Our interview has been edited and condensed for clarity.)
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Annie Nova: Your book starts with a quote by Tolstoy: “We imagine that their sufferings are one thing, and our life another.” How are we able to be so detached from the state in which so many others are living?

Matthew Desmond: The country is so segregated. I think many of us can go about our daily lives only confronting poverty from the car window or in the news.
AN: Many financially comfortable and well-off Americans, you write, live as “unwitting enemies of the poor.” How so? Can you give an example?
MD: Sure. We have this national entitlement program that’s just not for the poor. In 2020, the nation spent $53 billion on direct housing assistance to the needy, things like public housing or vouchers that reduced rent burden. That same year, we spent over $190 billion on homeowner tax subsidies. Those are things like the home mortgage interest deduction, which homeowners are entitled to. Protecting and fighting for those subsidies leaves less money with which to fight poverty.

Arrows pointing outwards

AN: So you think there should be fewer tax breaks like the home mortgage interest deduction and more policies to help poor Americans?
MD: I want to be clear: I’m not calling for redistribution. That entails giving up something that is mine and that I’ve earned. What I’m talking about is less rich aid and more poor aid. There was a study published recently showing that if just the top 1% of us just paid the taxes we owe — so not pay more taxes, but just stop evading tax bills — we as a nation could raise $175 billion more every year. That’s almost enough to pull everyone out of poverty.
AN: So getting the IRS to do more enforcement.
MD: Absolutely. When you are trying to fight for ambitious, bold solutions to poverty, you immediately run up against people saying, ‘Well, how will we afford it?’ And the answer is staring us right in the face. We could afford it if we allowed the IRS to do its job.

We can confront this issue in such a more robust way than we have. And it should shame us that we haven’t.

Matthew Desmond
sociologist and author

AN: Thinking that poverty in the U.S. is avoidable makes its existence feel so much worse.
MD: It makes it so much worse morally. We are such a rich country. We can confront this issue in such a more robust way than we have. And it should shame us that we haven’t. It should shame us that so many people are living with such uncertainty and agony.
AN: In what way do large companies in the U.S. profit from poverty in America?
MD: As union power started waning, wages started slagging. And then CEO compensation started growing. Corporations have used that economic power and transferred it into political power to make organizing hard and to combat unionization efforts.
AN: As a child, you blamed your father when he lost his job and the bank took your house. Why do you think that was?
MD: When you’re in the middle of something, you often grasp at the explanation that is closest to you, which is often about shame and guilt and blame. When I wrote my last book on families facing evictions, a lot of the families who lost their homes would blame themselves. But I think it’s the sociologist’s job, to quote C. Wright Mills, to turn a personal problem into a political one. Millions of people are facing this every year. This is not on you.

AN: You call on Americans to become “poverty abolitionists.” Why use the word “abolitionists”?
MD: I think that it shares with other abolitionist movements a commitment to the end of poverty. It views poverty not as something that we should get a little better at, but something we should abolish. Because it’s a sin. It’s a disgrace.
AN: What are the most impactful actions people can take to fight poverty?
MD: You can go to your Tuesday night zoning meeting in your community and you can support the affordable housing project that a lot of your neighbors are trying to kill. And you can say, “Look, I’m not going to deny other kids opportunities that my kids have had living here. I’m not going to embrace segregation. That ends with me.” You can shop at places that do right by their workers, and that don’t try to bust unions. There are also all these amazing anti-poverty movements in every state.
AN: I know you don’t have a crystal ball, but if more attention and resources aren’t directed at reducing poverty, what could the future look like for us?
MD: For folks who are struggling, it means a smaller life. It means diminished dreams. It means illnesses that don’t get solved. And for those of us who enjoy some security and prosperity, it means an affront to your sense of decency. If nothing improves, it really belies any claim to national greatness.

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Reports show consumer confidence is declining amid renewed recession fears.
The recent banking crisis was another blow to how most people feel about their financial picture.

When it comes to the U.S. economy, confidence is key. But the banking crisis has threatened to upset how most people feel about their financial picture.
“The bank problems are probably making a lot of people think twice,” said Diana Furchtgott-Roth, an economics professor at George Washington University and former chief economist at the U.S. Department of Labor.

“People are not as confident,” she said, referring to the “wealth effect,” or the theory that people spend less when they feel less well-off than they did before.
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As recent events prove, the line between Wall Street and Main Street has become increasingly blurred: When stocks fall, people tend to rein in their spending.
A decline in spending slows retail sales and that, in turn, triggers a market reaction that spills back onto consumers.
At the same time, income is going down — after adjusting for inflation — interest rates are going up and Federal Reserve Chair Jerome Powell says turmoil in the financial sector will cause banks to tighten their lending standards, making it even harder to borrow.

That leaves consumers with less access to cash to cover the rising cost of food, housing and other expenses. As households feel increasingly squeezed, that weighs on their confidence in the overall economic picture.

What it takes to feel financially secure

Americans now say they would need an average net worth of $774,000 to feel “financially comfortable,” but more than $2 million to feel “wealthy,” according to Charles Schwab’s annual Modern Wealth Survey. 
However, “it’s not how many dollar bills you have, it’s what you can buy with them,” said Tomas Philipson, University of Chicago economist and the former chair of the White House Council of Economic Advisers.
Any money earning less than the rate of inflation loses purchasing power over time.
The University of Michigan’s closely watched index of consumer sentiment recently fell for the first time in months. The Conference Board’s consumer confidence index is also down, according to the latest data.

Fewer consumers are planning to buy a home or car or spend money on other big-ticket items like a major appliance or vacation. That decline in spending paired with rising interest rates could likely push the economy into a recession in the near term, the Conference Board found.
Wall Street has been debating whether the country is heading into a recession for months, although many economists expected it to occur in the second half of this year.
Still, thanks, in part, to a strong labor market, the economy has remained remarkably resilient, dodging a downturn so far. 
“It remains to be seen if we will continue to do so, and partly it comes down to consumer confidence,” Furchtgott-Roth said. “People are definitely shaken up.”
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Recent bank woes and rising interest rates have many wondering what will happen next.
Experts say more market volatility may be in the forecast.

Recent bank woes and rising interest rates have prompted higher levels of economic uncertainty. When it comes to the markets, that means more volatility may be in the forecast.
Volatility happens when the value of an investment “fluctuates wildly in a short period of time,” according to the Financial Industry Regulatory Authority.

“In the months ahead, volatility may come and go,” Vanguard global chief economist Joe Davis said last week.
“And for all of us, I think it’s important to remember to focus on what we can control,” he said.
By staying invested in the markets, investors have a better chance of success when it comes to achieving their long-term goals, Davis said.

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However, the trick is stomaching the market drops to benefit from the gains that inevitably follow. Data from J.P. Morgan Asset Management shows that the market’s worst days tend to be closely followed by the best days.
There are a few things to keep in mind that can help you stick through market turbulence, advisors say.

“Staying the course is the play, because we can’t predict what’s going to happen this year, next year or in a decade from now,” Douglas Boneparth, president and founder of Bone Fide Wealth, a wealth management firm based in New York City, told CNBC.com in a February interview. Boneparth is also a member of CNBC’s Financial Advisor Council.
Here are four strategies that may help.

1. Match your risk to your goals

After dramatic market swings — from strong rallies in 2020 and 2021 to record declines in 2022 — many investors want to know, “When do things balance themselves out?” Boneparth said.
However, it would be best to instead focus on what is in your control: assessing the amount of risk you are willing to take and matching that to your investment time horizon, he said.
“These are the key pieces of information that will drive the investment decisions that we make,” Boneparth said.
If you are approaching retirement soon — from five years to as soon as next year — it may be time to reconsider your allocations, according to Stacy Francis, a certified financial planner and president and CEO of Francis Financial in New York.
“It’s a great opportunity to take a breath, have your portfolio rebound, and reevaluate after this time of real volatility to see, ‘Is this the right mixture of stocks and bonds for me for the long term?'” said Francis, who is also a member of the CNBC Financial Advisor Council.

2. Remember the most important part is staying invested

After you’ve identified the correct strategy for you, “The most important part of investing is to stay invested,” according to Boneparth.
That means having discipline and consistently putting money in the market, he said, while avoiding the impulse to sell based on short-term news.
“It’s important to remember that by staying invested, you’re playing the game of compounding your returns,” Boneparth said. “That’s how you grow your wealth.”
One thing to avoid: timing the market, which is “usually a fool’s errand,” he said.

3. Have cash set aside for emergencies

Investment exposure inevitably means taking on risk. Having cash separately set aside for emergencies can help make you better able to weather market losses — and know you’ll still be able to pay your bills.
Aim to have at least three to six months’ expenses set aside in an account you can easily access.
“It’s the first line of defense of recovering from a job loss and finding employment again,” Boneparth said.
Francis also advises clients to strive to have an emergency fund with three to six months’ expenses, she said.
Only once investors have their target emergency savings and have maxed out their retirement accounts should they consider investing their excess cash, Francis said. You should have at least five to 10 years before you will need the money, and your investments should include a well-diversified portfolio of stocks and bonds.

4. Stay humble

Even if you think you have a winning strategy, the market may still prove you wrong.
It’s a humbling experience, Boneparth said. But even some of the best portfolio managers on Wall Street can’t consistently beat the market, he said.
“As retail investors, what can we do? We can focus on the things that we can control,” Boneparth said.
That may include either a passive investing approach or a consistent investing approach, he said.
“One of these two things is usually going to pay off over the long term,” Boneparth said. More

A new Urban Institute study found that 73% of adults with medical debt owe hospitals at least some of it.
Of those who owed hospitals, 26% had a tab of $5,000 or more, compared with 6% among those who owed only non-hospital providers.
Even with health insurance, owing is not uncommon: 63% of adults with past-due medical debt incurred it when they were insured, the research found.

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Among the millions of Americans with past-due medical debt, there’s a decent chance they owe $1,000 or more, new research suggests.
While 39% of that cohort said they owe less than $1,000, the remainder (61%) owe more, including 21% who owe at least $5,000, according to the Urban Institute report, which is based on mid-2022 survey data.

“Medical debt, unlike a mortgage or car loan and things like that, we don’t really choose,” said Berneta Haynes, a staff attorney and medical debt expert for the National Consumer Law Center.
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“We don’t choose when we get sick … so medical debt comes as a bit of a surprise,” Haynes said.

The largest bills are mostly owed to hospitals

The Urban Institute study found that 73% of adults with medical debt owe hospitals at least some of it. Additionally, most of patients’ largest bills were owed to hospitals: About a quarter, 26%, had a tab of $5,000 or more, compared with 6% among those who owed only non-hospital providers (i.e., a  doctor or dentist).
“There are probably a number of explanations for the difference,” said Michael Karpman, author of the study.

“When people go to the hospital, they tend to face more higher-cost procedures, they may have greater health challenges, and there’s a lot of unpredictability about the charges and out-of-pocket costs that they’ll be facing, ” said Karpman, a principal research associate in the institute’s Health Policy Center.

Even among insured individuals, owing is not uncommon. Almost two-thirds, or 63%, of adults with past-due medical debt incurred it when they had insurance, the research found. Another 21% incurred it when the patients had no coverage and 16% had the debt occur during a time period in which they initially had coverage but then lost it or vice versa.

An estimated 100 million adults have medical debt

Overall, an estimated 41% of people — or about 100 million adults — face medical debt, ranging from under $500 to $10,000 or more, according to a report from the Kaiser Family Foundation. 
The reasons for such debt going unpaid vary from person to person. The two main causes, said Haynes, is having a chronic health condition or being uninsured — or, often, both.

Deductibles may be unaffordable for some patients

Additionally, many health-care plans have deductibles that are high enough to pose affordability challenges for some patients. Deductibles are the amount you pay out of pocket before your insurance plan begins covering your care (although you may still be required to pay a copay or coinsurance).

For example, if the patient has a deductible of $1,000 and is billed that amount all at once due to, say, a surgery or hospital stay that costs at least that much, it may be more than they have in savings, various research shows. For example, more than half of households would struggle to pay an unexpected $1,000 bill, according to a 2022 Bankrate survey.
“Having to pay a $1,000 deductible is out of the range of reality for a lot of folks and can lead to risky decisions, such as putting it on a credit card or taking out a medical credit card,” Haynes said.
The average deductible in 2022 among employer-sponsored health plans was $1,763, according to the Kaiser Family Foundation.
Other contributors to unpaid medical debt are short-term health plans and health-sharing ministries, according to the American Hospital Association. Those plans generally come with lower premiums but are not required to cover certain services and preexisting conditions, or limit out-of-pocket costs.

No Surprises Act is reducing unexpected bills

One of the biggest causes of unexpected large medical bills historically was out-of-network providers being involved in your care — often at a hospital — without you realizing it. Then the bill would come and you’d discover that your insurance didn’t fully cover those charges, if at all.
However, there are signs that the No Surprises Act has reduced many instances of unexpected, outsized bills. That legislation, which took effect in 2022, generally stops you from being billed at the out-of-network rate (although consumers should still be on the lookout for such charges due to billing mistakes).

Check whether you qualify for free or reduced care

If you are hit with a large medical bill from a hospital, be aware that many have financial assistance programs. While not all for-profit hospitals offer one, nonprofit facilities are required to have them, Haynes said.
Check the back of your bill to see if there’s information on a financial assistance program, she said. Or you can usually find it in the billing section of a hospital’s website.
Often, hospitals use 250% of the federal poverty level as the cutoff when determining a patient’s eligibility for free care or a reduced cost, the Urban Institute research notes.
The federal poverty level depends on the number of people in a household and is adjusted annually. In 2023, for a family of four, that amount is $30,000. So 250% of that is $75,000.

Some medical debt is dropping off credit reports

Separately, be aware that the three big credit-reporting companies — Equifax, Experian and TransUnion — made some changes last year to how they are handling past-due health-care bills.
As of last July, once you’ve paid off any medical debt that shows up on your credit report, it will be removed (previously, it could remain on your record for seven years). Additionally, consumers also now get a year, up from six months, before unpaid medical debt appears on credit reports once it goes to a collection agency.
The credit firms also said that in the first half of this year they will stop including any medical debt under $500 on credit reports. They are still on track to do that, according to a spokesman for the Consumer Data Industry Association.

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