• Private home insurers are dropping a growing number of customers in most states, a Senate report found.
• That leaves homeowners at risk, turning to more expensive last-resort options or going uninsured.
• While Florida has managed to reverse the trend somewhat, the risk to homeowners is set to intensify.

As Americans flock to places in the US vulnerable to natural disasters, private home insurance companies are running the other way.

The problem has left a rising number of homeowners with just one option to cover property damage: insurers of last resort.

The scale of homeowners losing their plans became clearer on Wednesday after a Senate Budget Committee investigation found that private insurers' nonrenewals spiked threefold in more than 200 counties between 2018 and 2023.

"What our new data reveal is that the failure to deal with climate change is also affecting whether families can even get homeowners insurance, which threatens their ability to get a mortgage, which spells trouble for property values in climate-exposed communities across the country," Senate Budget Chairman Sheldon Whitehouse said in releasing the report.

A recent study by Harvard University's Joint Center for Housing Studies found that between 2018 and 2023, the number of properties enrolled in California and Florida's insurers of last resort more than doubled. A similar trend is playing out in Louisiana. While Florida has reduced participation this year, it still has the highest enrollment in the country.

The problem isn't isolated to the most predictable states. The Senate Budget Committee found that the rate of homeowners losing their private insurance also rose in Hawaii, North Carolina, and Massachusetts.

Policymakers and insurers are trying to stabilize the private market, by enacting new laws and overhauling regulations. However, with scientists predicting that climate-fueled disasters will become more frequent and severe for the foreseeable future, the risk to America's homeowners is mounting.

Growing insurance risk has some states looking for solutions

In nearly three dozen states, insurers of last resort, known as Fair Access to Insurance Requirements, or FAIR, are available to homeowners and businesses who struggle to find insurance on the private market.

The numbers are rising because private insurers are pulling back coverage and hiking premiums in areas at risk of wildfires, hurricanes, flooding, and other disasters often made worse by climate change.

While state-mandated FAIR plans are designed to be a backstop, insurance regulators and private insurance companies are alarmed by how many homeowners and businesses are enrolling, especially in California and Florida. The plans are often more expensive and provide less coverage. Plus, saddling one insurer with the riskiest policies increases the chances of one major disaster sinking the system and leaving taxpayers and insurance companies with the bill.

Florida and California are trying to reverse the trend, and Florida has seen some progress. The state's insurer of last resort, Citizens Property Insurance Corporation, said on December 4 that its policy count dropped below 1 million for the first time in two years.

Mark Friedlander, a spokesperson for the Insurance Information Institute, said the drop reflects a series of changes in recent years to stabilize the state's private insurance market after more than a dozen companies left the state or stopped writing new policies.

The Florida legislature passed laws to curb rampant litigation and claim fraud that drove up legal costs for private insurers. Friedlander said insurance lawsuits in the first three quarters of 2024 are down 56%, compared with the first three quarters of 2021 — the year before the new laws were enacted. Citizens also started a "depopulation" program that shifts customers to the private market. State regulators in October said they had approved at least nine new property companies to enter the market, and premiums weren't rising nearly as much as last year.

In California, many of the deadliest and most destructive wildfires have occurred within the last five years. As a result, some private insurers are hiking premiums and limiting coverage in risky areas, pushing more homeowners to the insurer of last resort. The Harvard study found that policies in the state's FAIR plan doubled between 2018 and 2023 to more than 300,000. As of September, the California Insurance Commission said policies totaled nearly 452,000.

The commission is working to overhaul regulations to slow the trend, including requiring private insurers to sell in risky areas. In exchange, it should be easier for companies to raise premiums that factor in reinsurance costs and the risks of future disasters. That should help stabilize rates, said Michael Sollen, a spokesman for the commission.

Sollen added that in the past, private insurers could seek approval for higher premiums but weren't required to offer coverage in wildfire-prone areas.

"In a year from now, what's happening with the FAIR plan will be a key measure for us," he said. "We expect to see those numbers start to stabilize and go down."

A mounting home insurance crisis

Still, a reduction in state-backed plans isn't necessarily a sign of progress, Steve Koller, a postdoctoral fellow in climate and housing and author of the Harvard report, told Business Insider.

A growing number of homeowners in places like Florida, Louisiana, and California are purchasing private insurance from nontraditional providers barely regulated by state governments. These so-called "non-admitted" insurers don't contribute to a state fund that guarantees homeowners will have their claims paid even if the insurance provider fails, leaving their customers without access to this backup coverage.

"Someone could be moving to a private insurer from Citizens, and that insurer might have higher insolvency risk," Koller said.

He added that more homeowners are opting out of insurance altogether. The number of US homeowners going without insurance has soared from 5% in 2019 to 12% in 2022, the Insurance Information Institute reported.

Plus, Americans are increasingly moving into parts of the country most vulnerable to extreme weather. Tens of thousands more people moved into the most flood—and fire-prone areas of the US last year rather than out of them, the real estate company Redfin reported earlier this year.

As insurers of last resort try to shift more risk to the private market, home insurance premiums are expected to keep rising. That's especially true in the areas hardest hit by climate-fueled disasters.

If private insurers exit hard-hit regions en masse in the future, Koller said states might need to become the predominant insurance provider in the same way the National Flood Insurance Program took over after the private market for flood insurance collapsed in the 1960s. Most flood insurance plans are still issued by the federal government.

"My guess is states are going to work very, very hard to avoid that and ensure the existence of a robust private market, but that's a parallel that I can't personally unthink about," he said.

Have you struggled to get home insurance, moved to an insurer of last resort, or gone uninsured? Contact these reporters at [email protected] or [email protected].

• The richest of the rich can use life insurance to avoid estate and income taxes.
• Private-placement life insurance is perfectly legal — unless a new bill passes.
• A financial advisor tells Insider how the insurance saves the wealthy tens of millions of dollars.

Life insurance is probably the least sexy area of financial planning. But for the richest of the rich, policies can slash tens of millions of dollars off their tax bills.

Private-placement life insurance is a little-known tax-avoidance tactic. When structured correctly, PPLI policies can be used to pass on assets from stocks to yachts to heirs without incurring an estate tax.

"In the US, people sell life insurance as a middle-class way of structuring assets," Michael Malloy, a wealth advisor who has specialized in PPLI for 20 years, told Business Insider in 2022. "But PPLI is a completely different animal."

The PPLI industry enables a few thousand ultra-rich American taxpayers to shelter at least $40 billion, according to an investigation by the Senate Finance Committee. The report estimated that the average PPLI policyholder is worth well over $100 million.

PPLI is legal—for now. On December 16, Oregon Sen. Ron Wyden released a draft bill to close the loophole. Under the Protecting Proper Life Insurance from Abuse Act, PPLI policies would be treated as investment funds, not life insurance or annuity policies, which would eliminate the tax benefits.

"Life insurance is an essential source of financial security for tens of millions of middle-class families in America, so we cannot have a bunch of ultra-rich tax dodgers abusing its special tax treatment to set up tax-free hedge funds and shelter oodles of cash," Wyden said in a written statement.

While tax savings are the primary draw of PPLI for US clients, those in the Middle East or Latin America are often looking to use trusts to conceal information about specific assets from corrupt governments, Malloy said.

"Clients don't want an organized crime ring bribing an underpaid tax official to get information on their family," he said.

US taxpayers are required to report to the IRS only the cash value of a foreign life-insurance policy, not the assets within the trust.

These offshore life insurers in jurisdictions such as the Cayman Islands and Bermuda typically require at least $5 million as the upfront premium. Malloy advises that clients have at least $10 million in assets to make PPLI worthwhile. His clients usually hold at least $50 million in assets.

Here is how PPLI works

In short, an attorney sets up a trust for a wealthy client. The trust owns the life-insurance policy that's created offshore.

The PPLI policy premiums are funded with assets. The assets must be diversified — typically with at least five different asset classes — and can include stocks and business interests, as well as tangible assets like yachts and real estate.

Depending on the client's age, nationality, and other factors, the death benefit can, in theory, max out at $100 million, Malloy said.

If structured correctly, the benefit and the assets in the policy are passed to the children without incurring an estate tax. A 40% federal estate tax applies to estate values topping $13.61 million for individuals and $27.22 million for married couples.

Unlike with policies from US insurers, clients can cancel their policies without paying a massive surrender fee. The assets also grow within the trust tax-free. The cash value of the PPLI policy assets is held in a separate account, and this cash can be disbursed to the policy holder or invested. Investing in hedge funds is a popular use of PPLI assets.

But there's a catch. Policyholders have limited control over investment decisions. They cannot give directives to the asset manager to buy a certain number of shares in Apple, for instance.

It also requires a small army of professionals, including trust and estate attorneys, asset managers, custodians, and tax advisors. Since PPLI is relevant only to the ultrawealthy, few in wealth management or law are familiar with it.

"There's no questions on the CPA exam or the bar exam about PPLI, and asset managers are kind of skeptical," he said. "They think you're going to take assets away. Actually, the assets become stickier and get more alpha because the client pays less tax."

How the proposed bill would endanger PPLI

Under Wyden's proposed legislation, most PPLI policies would be classified as "private placement contracts" (PPCs) rather than life insurance policies. As such, any accumulated earnings and death benefits would be taxed.

The bill would apply to future and existing PPLI policies, giving policyholders 180 days to liquify the assets or transfer them. Insurers who dare to issue or reinsure the policies will no longer have the benefit of secrecy. To better enable the IRS to enforce the bill, insurers will have to report all PPCs or face a $1 million fine for each 30-day period that they fail to do so.

The bill faces steep odds of passing with Donald Trump's reelection and a Republican House and Senate. The insurance industry is counting on it.

"This legislation is an attack on all forms of permanent life insurance and, by extension, an attack on holistic financial planning," said Marc Cadin, CEO of trade group Finseca, in a statement. "We look forward to working with the new Congress and the Trump administration to advance policies to move our country forward rather than raising taxes on life insurance."

• Holden Karau works in Big Tech during the day and builds her startup, Fight Health Insurance, at night.
• Karau said personal experiences with health insurance denials led her to create the platform.
• The platform uses AI and machine learning to streamline the insurance appeal process.

Holden Karau works as an open-source engineer in California — but just about every day after work, she's building Fight Health Insurance, a free AI-powered platform designed to help people appeal healthcare claim denials.

The 38-year-old Canadian has worked in the big data space for years, previously holding jobs at every FAANG company aside from Facebook.

Karau told Business Insider that while she had never worked on anything healthcare-related, her personal experiences with health insurance claim denials in the US led her to create an open-source tool to automate as much of the appeals process as possible.

Karau said that she's "seen different healthcare systems and the trade-offs," and the Canadian version isn't "perfect either." However, she grew increasingly frustrated with the US healthcare system while seeking out trans healthcare in California and recovering from a motorcycle crash.

Karau said denied claims lead to "a lot of suffering in the world today," and those challenges led her to start working on the AI project to help dispute health insurance denials.

"I'm not going to put up with this anymore. It's time to fight back," Karau said she told herself as she set out to build the tool. "And I think that's probably where the name came from."

She told BI that a later experience navigating her dog's pet insurance pushed her "over the edge" and made her determined to turn the proof of concept into a consumer product other people could use.

"I was like, I've had enough. This needs to not just be like a curiosity," Karau said. She wanted to "make it accessible to the average person," which factored into the decision to make it a free service.

Now, anyone in the US can generate an appeal with Fight Health Insurance by inserting some basic information, uploading a claim denial letter, and, if relevant, their plan documents.

The platform uses machine learning to identify and confirm details, and a fine-tuned large language model to pull data from PubMed, Karau said. The company uses an in-house AI tuned from a base model from Mistral AI, Karau said. To ensure patients' privacy, the system helps anonymize information by removing names and addresses.

Once the appeal is generated, users can review and edit it before mailing it off — or have the company fax it for $5. Karau said she added the faxing service after receiving emails from users saying they loved the platform but didn't have a printer and it was costly to get it printed somewhere else.

"It's a little weird working on an AI project and then going on to eBay to buy fax modems," Karau said. "But, hey, what is life if not a little weird?"

With insurers increasingly using AI to sift through claims, Karau said Fight Health Insurance offers a way to "level the AI playing field." She said while she wants doctors to make decisions about medications and diagnoses, she sees an opportunity for more AI tools to be used in the grunt work of dealing with insurance. Karau said AI could be useful in following up with patients after appointments, whether it be for reminders about surgery or to submit an out-of-network provider form.

The company now has two full-time staff and a few part-time contractors. Eventually, Karau said she plans to monetize the platform by building a professional version for hospital systems and medical vendors, who are also "feeling the pain from health insurance denials."

"Doctors are just super frustrated with all the time they spend dealing with insurance companies," Karau said.

Karau said that she plans to keep the consumer version free, aside from the $5 optional cost to have the company fax out an appeal.

"I think that it's really important that patients don't want to pay to use Fight Health Insurance because they already pay so much," Karau said.

Since launching the side project in August, Karau said over 1,000 have used the platform to help generate an appeal, and a handful have reached out to her to share success stories. She said just the other day she was talking to someone whose back surgery was successfully appealed using Fight Health Insurance.

"Now they're looking forward to getting back to riding motorcycles next year," Karau said.

Exactly how many of those appeals were successful isn't clear because users get responses directly from their health insurers rather than through the platform. The company also doesn't store user emails unless users opt-in, Karau said, so it currently doesn't have a way to follow up with people to learn the outcome unless they choose to share their contact information. However, she plans to incorporate replies from the platform in the future professional version to better track success stories.

In regard to recent conversations about the health insurance industry following the shooting of UnitedHealthcare CEO Brian Thompson, Karau said she understands the intensity of emotions surrounding what can sometimes be life-or-death treatment decisions made by insurance companies.

She also said there's been an increase in traffic to the Fight Health Insurance website in the wake of the larger discussion online about frustrations with the healthcare system in the US.

"I think consumers are hurting a lot in the health insurance space right now," Karau said.

• Over 2,000 older Americans and counting have shared their financial and other regrets with BI.
• Some experienced financial distress after losing their spouses to illness or accidents.
• This is part of an ongoing series about older Americans' regrets.

Karen Lauer's husband died without a will. On top of the grief of losing the person she loved, Lauer's finances were thrown into chaos.

She's one of many older widows and widowers who have shared their stories with Business Insider in recent months. They're among the more than 2,000 Americans who've responded to a reader survey about their life regrets. This story is part of an ongoing series.

Some widows told BI they lost substantial amounts of their household income or were thrust into complex legal battles for their spouse's assets.

Others regret not outlining a will, skipping a life-insurance policy, or not building savings before their spouse's death: "Having been widowed twice and left with three girls to raise alone, I wish I would've saved money for my retirement years," one survey respondent wrote.

"I hate living without my husband — I needed to prepare for widowhood while making the most of our last years together," another said.

For Lauer, sorting through the pieces of her husband's estate has been painful.

"Because we didn't have a will, I feel like I'm going through a divorce between my dead husband and myself," Lauer said.

We want to hear from you. Are you an older American with any life regrets you'd be comfortable sharing with a reporter? Please fill out this quick form.

How losing a partner can take a painful financial toll

Lauer, 64, smiles thinking about the man nicknamed "Cowboy Steve." She pictures him cantering on his horse at their ranch in western Nebraska, gathering a thin layer of dust on his leather boots.

Her husband died following an accident last year. Without a will, she said the local court told her that all of her husband's money and assets would go into probate, a legal process used to divide a deceased person's estate, typically among their blood relatives. Lauer said because the ranch was in Steve's name, not hers, she was required to move off the ranch during the process so the house could be sold. She said she's now experiencing homelessness.

She's house-sitting for a friend in Lincoln, Nebraska, but doesn't know where she'll live next. With limited savings of her own, Lauer said she's surviving on less than $2,000 in monthly Social Security payments. She said it's not enough to cover essentials or rent her own apartment.

Lauer's financial experience mirrors that of others. In fact, on average, widows have lower 401(k) balances, less savings, and a more limited monthly retirement income than married retirees, BI found in an analysis of individual-level data from the Census Bureau's 2023 Survey of Income and Program Participation.

The average monthly income of widowed retirees is higher than that of divorced retirees and retirees who never married. But at an average of $2,381 monthly, their income is still several hundred dollars lower than that of married retirees with a surviving spouse. The analysis looked at retirees' income from pensions, Social Security, retirement accounts, or insurance benefits.

Doug Ornstein, the director of wealth management at TIAA, told BI that losing a spouse could have "devastating" financial impacts.

"If the person who handled most of the money passes away unexpectedly or early, the surviving spouse might not have financial literacy," he said. "Or maybe the couple undersaved for retirement — that person has to figure it out themselves."

A report published in June by the financial firm Thrivent found that less than half of widowed women feel prepared to manage their finances after a spouse's death. Twenty-nine percent of women surveyed said they created a will with their spouse, while 41% said they had no financial plan before their spouse's death. The firm surveyed a national sample of 422 female widows in May 2024.

Lauer wishes her "marriage license came with instructions," she said. Steve died unexpectedly, and Lauer said she didn't have enough knowledge about the probate and asset-division process, or how it would affect her livelihood as the surviving spouse. She advises other married people to write a will and make a financial plan as soon as possible.

How to protect your finances if your spouse dies

Ornstein said there are a few key ways that Americans can financially protect themselves if their spouse dies.

The first step is creating a will and having regular conversations about finances as a couple. A life-insurance policy — which people can buy or opt in to through their employer — can provide further financial security to a deceased person's family after their death. Typically, people pay a regular premium for the insurance throughout their career and can name a spouse or children as their beneficiaries.

Ornstein told BI that widows and widowers should work with an estate-planning attorney, financial advisor, and tax professional directly after their spouse dies. He added that, when preparing for those meetings, it's best to collect as many legal and financial documents as possible: a death certificate, a marriage license, bank statements, tax returns, benefits paperwork, insurance policies, and a will.

With an attorney and financial advisor, widows and widowers should apply — or reapply — for benefits such as Social Security and pensions, Ornstein said. They may be entitled to spousal benefits or higher monthly government aid. He added that a surviving spouse would likely have to transfer ownership of assets like a house, credit card, retirement account, or loan to themself or another family member.

"Take things one step at a time," he said in a follow-up email. "It's normal to feel stressed, overwhelmed, and anxious in this situation."

Still, not all widows or widowers have regrets about their money habits, even if they're in a precarious financial position.

Looking back on his 48 years of marriage, Robert Berkeley feels good about how he spent his money. He and his wife, Lourdes, spent decades traveling, dining at their favorite restaurants, and hosting big family holiday gatherings in their eastern North Carolina home. After their respective careers as an intelligence analyst and a dental hygienist, the couple decided to retire in their 60s — living largely on their monthly Social Security checks and the few thousand dollars they had saved.

Twelve years later, in 2022, Lourdes was diagnosed with cancer. The disease was aggressive, and she died within a couple of months.

Now 78, Berkeley is struggling to make ends meet. He and his wife didn't have a life-insurance policy or robust savings. He said it's been difficult to afford housing, utilities, groceries, and transportation without two Social Security incomes. Berkeley receives a $1,650 monthly payment, but he's in debt and behind on bills. He's hoping the part-time security guard job he landed recently will help fill the gaps.

Despite his limited budget, Berkeley feels at peace with past spending habits: "We decided to live our life in our 30s, 40s, 50s, 60s, right up to hitting our early 70s," he said. "We weren't the kind to squirrel money away for something that might happen in the future."

The couple lived — and spent — in the moment, he said. He may not have much wealth left as he ages, but Berkeley said it's worth it for the years he had and the memories he made with his "darling wife."

Are you struggling with finances after losing a spouse? Are you open to sharing your experience with a reporter? If so, reach out to [email protected].

• Warris Bokhari founded Claimable to tackle insurance-claim denials using AI technology.
• Bokhari says denial is a major issue in the US healthcare system, causing fear about getting help.
• Claimable's AI-driven platform boasts an 85% success rate in overturning claim denials.

After working in the insurance industry, Warris Bokhari saw that claim denial was a core issue in American healthcare.

So around two years ago, Bokhari started working on Claimable, an AI startup launched in October that aims to fight claim denials for a growing list of treatments.

"It's no wonder why people give up," the Claimable cofounder and CEO told Business Insider. "If you're a rational person, you would say this model was not fit for purpose."

Bokhari was raised in the UK and grew up with two disabled parents. Unlike people in the US, his parents never went bankrupt because of medical expenses, he said. He went on to work as an ICU doctor in the UK, where, he said, there was "never a time" when a necessary treatment was denied to a patient. When he came to the US, Bokhari continued working in the healthcare industry, including a two-year stint at insurance company Anthem.

In the US, he said, "there's no guarantee" of getting the medical care you need. Insurance companies can end up feeling like an obstacle, and that dynamic has created "fearfulness" about getting sick and seeking out help, Bokhari added.

The insurance industry has faced renewed scrutiny amid the fatal shooting of UnitedHealthcare CEO Brian Thompson. While the motive behind Thompson's killing is under investigation, many of the responses to his death online have disclosed deep frustrations with the insurance industry.

Bokhari said the company didn't support violence toward individuals. "That is not the productive solution," Bokhari said. "The productive solution is appealing."

Claim-denial rates have been increasing for more than a decade. The health policy and research firm KFF reported that 17% of in-network claims by HealthCare.gov insurers were denied in 2021. The same report found that 41% of appealed claims got overturned, though less than 1% of consumers went through the process. Recent criticism has also been directed toward insurance companies that can rely on algorithms to assist in claim decision-making.

Bokhari said that Claimable had helped file hundreds of appeals and that its success rate of overturning denials was about 85%. It joins several startups leveraging AI to improve the insurance process.

Patients start by describing their experience of living with the condition and what it would mean to get denied their requested treatment. The platform then uses AI to analyze millions of data points from clinical research, appeal precedents, policy details, and the individual's medical history to generate a customized appeal within minutes.

Most Claimable appeals cost patients $39.95, plus shipping.

Claimable supports claims appeals for more than 70 FDA-approved treatments for autoimmune and migraine sufferers, some of which may have been denied because of medical necessity or being out of network. In addition to faxing and mailing the appeal to the insurance company, Claimable also sends a copy to every regulator that would have oversight of the insurer.

"Regulators probably assume that these denial cases are occasional," Bokhari said. "They make big headlines, but they don't know that these very private tragedies happen every day in American life."

Bokhari said patients "have a right to be heard," and Claimable helps legitimize those patients' stories.

Claimable closed its seed round in March, backed by Walkabout Ventures, Humanrace Capital, and others. The company is a part of Nvidia's startup program and has a team of about 11 employees.

• Health insurers are coming under fire for increasingly denying patient claims for medical care.
• Investors are rushing to back startups using AI to automate the complex healthcare billing process.
• These 10 startups are helping patients, providers, and insurers improve health payments with AI.

In the wake of the fatal shooting of UnitedHealthcare's CEO last week, public hostility toward health insurers has reached a boiling point.

After Brian Thompson was shot and killed in Manhattan on December 4, social media exploded in morbid celebration. Shell casings found at the scene of the crime reportedly showed the words "deny," "defend," and "depose," mirroring a phrase commonly used by insurance critics to describe tactics used by health plans to avoid paying claims. Suspect Luigi Mangione was arrested Monday with a note in his possession containing the line, "These parasites had it coming."

It's a reckoning for how healthcare in the US is paid for — or not paid for — as health insurers increasingly deny paying for patient care. UnitedHealthcare and other health insurers have come under fire in recent years for using algorithms to deny patient claims, particularly Medicare Advantage claims. Claim denial rates have been on the rise for more than a decade, and denied or delayed payments cost hospitals hundreds of billions of dollars a year.

A growing crop of startups think AI can help.

Investors are rushing to back startups using AI to help providers, patients, and health plans more accurately and efficiently pay for medical care.

These 10 startups are using AI to automate key parts of healthcare's complex billing process, from prior authorization to claims adjudication.

Alaffia Health

Founded: 2020

Total raised: $17.6 million

What it does: Alaffia Health works with health plans to automate time-consuming tasks in claims processing, such as reviewing large patient medical records and policy documents. The startup says its generative AI tools can help insurers supercharge their in-house clinical teams and reduce claims spending.

Alaffia Health last raised a $10 million Series A round in April led by FirstMark Capital.

Anomaly

Founded: 2020

Total raised: $30 million

What it does: Anomaly uses machine learning to parse health insurers' policies and historical claims data to help clinicians predict and prevent claims denials. The startup was incubated by Redesign Health and has raised money from investors like RRE Ventures and Madrona.

Anterior

Founded: 2023

Total raised: $23 million

What it does: Anterior provides tech to clinicians working inside health insurers to automate prior authorizations for covered medical care. The startup raised a $20 million Series A led by NEA in June. It's also backed by Sequoia Capital and Microsoft AI head Mustafa Suleyman.

Claimable

Founded: 2023

Total raised: Undisclosed

What it does: Claimable launched in October to assist patients in creating appeal letters for denied medical claims. Its platform analyzes a range of data, including clinical research, insurer policies, and existing appeals data, to generate a personalized letter for $40.

The startup last raised a seed round from Walkabout Ventures, Humanrace Capital, and other investors in March. It's also part of Nvidia's startup accelerator program Inception.

Cofactor AI

Founded: 2023

Total raised: $4 million

What it does: Cofactor AI's platform analyzes information, including medical records, insurer policies, and claims data, to help hospitals appeal claims denials. The startup announced a $4 million seed round led by Drive Capital in November.

Cohere Health

Founded: 2019

Total raised: $106 million

What it does: Cohere Health contracts with health plans like Humana and Geisinger to automate prior authorizations for medical care. The startup claims its tech can reduce the number of unnecessary prior authorization denials to help patients get the care they need faster. Cohere Health last raised a $50 million Series B extension in February led by Deerfield Management.

Humata Health

Founded: 2023

Total raised: $25 million

What it does: Humata Health works with hospitals to automate the collection of documents included in requests for prior authorizations sent to insurers and flag likely denials. The startup raised a $25 million Series A in June, led by LRV Health and the Blue Venture Fund.

Dr. Jeremy Friese started Humata Health after serving as the president of health AI startup Olive, which shut down last year after selling its prior authorization business to Humata.

Goodbill

Founded: 2021

Total raised: $5.3 million

What it does: Goodbill works with patients and employers to reduce medical costs by cross-referencing medical records with incoming hospital bills to identify potential errors and overcharges. The startup last raised a $2 million funding round in March from Founders' Co-op, Maveron, and Liquid 2 Ventures.

Guardian AI

Founded: 2024

Total raised: Undisclosed

What it does: Guardian AI provides hospitals and physician groups with tools to analyze insurance reimbursement patterns and automate the handling of unpaid medical claims and denials. The startup was part of YCombinator's summer 2024 cohort; its founders previously worked on Palantir's AI revenue cycle management programs for hospitals.

Thoughtful AI

Founded: 2020

Total raised: $40 million

What it does: The startup's AI agents help healthcare clinics process medical claims, check patient insurance coverage, and record payments. Thoughtful AI last raised a $20 million Series A in July, led by Drive Capital.

• Many workers struggle with choosing their health-insurance plans during open enrollment.
• Some healthcare companies are employing mobile apps and generative AI to help smooth out the process.
• This article is part of "Trends in Healthcare," a series about the innovations and industry leaders shaping patient care.

During open-enrollment season, Reddit users inundate the platform's forums on health insurance and personal finance every day, asking how to best pick from their health-insurance options.

In one post, a recently unemployed married woman in Texas asked whether she should enroll with her husband's employer or stick to COBRA, which provides benefits to people who have lost their jobs. Another married person requested advice on which coverage to pick if they're planning to have a baby in 2025. For an employee in California, fellow Redditors were a sounding board as they navigated dental-plan options, with costs ranging from $0 to nearly $440 annually.

Open-enrollment season typically takes place between October and December, and companies have their own set periods within those months. During this time, Americans elect their health-insurance coverage through either a private employer or marketplaces via subsidies offered under the federal government's Affordable Care Act. Nearly all open-enrollment selections made this fall will go into effect on January 1 and be set until the following season, with a few exceptions.

The process can be immensely confusing.

Employees are expected to look both backward and forward, said Dan Beck, the president and chief product officer for SAP SuccessFactors, a cloud-based software platform that oversees HR, payroll, and talent management.

He told Business Insider that employees are tasked with reflecting on whether they maximized their benefits in the past year based on how much they tapped into the healthcare system. At the same time, they must anticipate health-related events, such as having a child or a major surgery.

To complicate matters further, workers may move to new roles with different insurance options or their employers could change providers or plan options, forcing employees to acquaint themselves with new choices. The makeup of their families could change, too: As employees' marital statuses change and they raise children, they'll likely want to optimize their healthcare plans for those life stages.

On Reddit, people making health-insurance decisions try to make sense of the complexities. If they choose health plans mismatched with their needs, they run the risk of overspending in two directions: shelling out for a premium-coverage plan they don't really need or skimping on coverage and then experiencing an expensive life change.

Employees also need to keep track of life events that could change their coverage, including moving, having a baby, or adopting a child. There is a special enrollment period, outside of open enrollment, for those life events, but also a limited period of time to make the changes and retain health care coverage.

Increasingly, employers are encouraged — by both their employees and their HR-benefits companies — to share more easily digestible benefits information.

"What employees are telling us, overwhelmingly, is that they need help when they are enrolling," Karen Frost, a senior vice president at the cloud-based employee-benefits vendor Alight, told BI.

Some employers are partnering with third-party companies that handle things like payroll and health benefits and have built software with with clear step-by-step prompts — which can help workers be confident about their healthcare elections.

Young workers want more employer support in demystifying healthcare

In Alight's 2024 annual survey of 2,500 employees in the US, the UK, France, Germany, and the Netherlands, 63% of workers said they felt confident about their most recent health-plan election.

There are, however, some generational splits in the data. In the survey, 70% of Gen Z and 72% of millennial workers said they wanted personalized support for navigating the health system versus just 46% of baby boomers.

Before the mass digitization of benefits elections, employers would hand their employees printed packets outlining their medical-insurance offerings and ancillary benefits such as dental and vision, retirement plans, commuter reimbursement, gym memberships, and other wellness programs. Employees would pick from that menu, largely without guidance or input on what they'd like to see as alternative or additional benefit options.

Though the paper-packet method is much less common now, the enrollment process can still be overwhelming to navigate.

Life changes, like moving to a new state or employer, or a company picking new insurance providers to work with can complicate the enrollment process.

"You have a narrow window to actually get benefits, and you want to be successful," Beck told BI.

Mobile apps and generative-AI tools aim to smooth out the open-enrollment process

To help employees sort through their options during the open-enrollment period, some healthcare startups are leveraging mobile apps and generative-AI chatbots.

Alight, for example, aims to learn more about employee preferences and the needs of their families through a Q&A and then make recommendations. Throughout this process, Alight's recommendations coincide with clear definitions of complex benefits, like a health savings account, which lets workers set aside pretax money for qualified medical expenses.

"Instead of just letting people make their own choice, we guide them," said Frost. As an example, if an employee were to pick a high-deductible health plan, Alight would guide them to an HSA and explain why enrolling in it may make sense to budget for potential healthcare expenses.

SAP SuccessFactors said it's not yet comfortable with offering suggestions for health-insurance elections, citing concerns about data privacy.

Instead, the company — which has customers including McDonald's, L'Oréal, and Delta Air Lines — said it's focusing on further developing its recently launched mobile app.

The SuccessFactors mobile app is targeted at two demographics: workers under 40 who tend to be mobile-first in nearly every aspect of their lives and frontline workers of all ages with jobs in manufacturing and other sectors where they may be without frequent access to computers.

SAP SuccessFactors is also using generative-AI chatbots to answer policy questions to improve the user experience. In the future, the company plans to use these chatbots to automate some open-enrollment processes.

To bolster the company's abilities to help employees navigate this process and other healthcare questions that may arise throughout the year, SAP earlier this year paid $1.5 billion in cash to buy WalkMe, a tool designed to provide real-time website navigation for healthcare, onboarding, and other employee-focused tasks.

AI-based virtual assistants are also becoming more pervasive in the open-enrollment process. Alight has Ask Lisa, SAP SuccessFactors is leaning on the company's artificial-intelligence copilot, Joule, and the HR- and financial-software provider Workday uses Wex, an AI chatbot that internal employees can access on Slack to get automatically generated responses to their benefits questions. The same tool is offered to customers but branded as Workday Assistant.

"We try to appeal to all generations and age groups," Ben Carter, the senior vice president of business partners and rewards at Workday, said. "Some people, the last thing they want to do is actually talk to somebody on the phone."

This emerging technology benefits employers, too. Earlier this year, Workday unveiled an AI-enabled tool called Workday Wellness, which integrates with insurance providers like Aetna and Cigna. It allows Workday's customers — like The Hartford, Guardian, and MetLife — to understand which wellness benefits employees are using and which ones aren't resonating so they can invest more strategically.

"It brings a nice story," Carter said, "to say, well, if I'm going to go invest another $20 million in my benefits programs next year, here's where I need to go, or here's where I need to double down, or here's where I need to stop investing."

• More than 58 million Americans have had packages stolen in the past year, per a recent survey.
• Now, one startup is launching a service to insure against porch pirates.
• PorchPals founder James Moore explains the surprisingly tricky math needed to solve the problem.

Following the largest day of online shopping ever on Cyber Monday, hundreds of millions of packages have by now reached doorsteps across the US.

But an untold number of those deliveries have also likely found themselves snatched up by someone other than the person to whom they belong.

Now, one startup is launching a service to insure shoppers against these so-called porch pirates.

"We want our service to be used by the consumer when they need us," PorchPals CEO James Moore told Business Insider, "You know, when those Christmas gifts get stolen, that or that Xbox, or that PlayStation, or that pair of Nikes that cost you $300."

The service, which officially goes live on Monday, covers up to three stolen packages a year or a maximum claim of $2,000 for an annual fee of $120. Customers link their payment card to the service and all future e-commerce purchases made with that card are covered, the company says.

As with any insurance product, there is some surprisingly tricky math that goes into putting a tidy number on such a messy problem like parcel theft.

Moore told BI that PorchPals used three separate actuarial teams working independently on the problem to reach a comparable risk profile. The teams represented some industry heavy-hitters, including Lockton Re, Pinnacle Actuarial Resources, and PorchPal's underwriters at Lloyds of London's Newline Syndicate.

Over the past year, more than 58 million Americans are estimated to have had one or more packages stolen, according to a recent survey from tech reviews website Security.org.

Of course, some households experience multiple thefts, and PorchPals estimates the number of stolen packages at around 119 million last year.

In an earlier trial in California, Moore said PorchPals users typically used the service for packages worth between $250 and $280. That figure represents an unfortunate sweet spot in the world of missing parcels: Shipments worth $2,000 or more tend to require a signature at delivery, and refunds for less than $50 can often be processed without too much hassle by retailers who want to keep their customers happy.

Once the value gets above a hundred bucks, police reports and other documentation can start complicating the picture.

The Security.org survey found the median package value that customers reported to law enforcement was $195, while the median value of unreported packages was $50.

Those higher-value losses can lead to a loop of calls to retailers, delivery companies, local police, and back again.

"At some point you've called everybody," Moore said.

Moore said shoppers may not realize how impractical other forms of protection really are in the case of package theft. For instance, homeowner and renters insurance policies typically have higher deductibles than make sense for a $250 claim. Credit card policies can have requirements that packages be reasonably protected against theft, he said.

From a risk perspective, Moore said the nature of package theft makes it different from other property crimes, such as how ZIP code crime rates can affect auto insurance premiums.

"It's not the ZIP codes that you'd think," he said. "In porch theft it's different. The thief is looking for high-dollar items."

Porch pirates may steal from all income levels, but Moore says some of the more expensive packages are snagged from wealthier doorsteps that might otherwise have "this aura of safety," such as gated communities or luxury condos with a concierge desk.

"The number of packages just sitting out there, just left to the open… I mean, it's vast," he said.

• Officials reportedly found bullet casings with the words "deny," "defend," and "depose" on them at Brian Thompson's murder scene.
• The words are similar to the title of a 2010 book about the insurance industry, "Delay Deny Defend."
• Police have not yet shared a motive for the shooting.

The gunman who shot Brian Thompson, the CEO of UnitedHealthcare, reportedly left behind a cryptic message at the crime scene.

Update: A "person of interest," 26-year-old Luigi Mangione, was arrested in connection with Thompson's death in Altoona, Pennsylvania, on Monday.

Multiple news outlets said that the shell cases found at the scene were inscribed with the words "deny," "defend," and "depose." These words are similar to the title of Jay M. Feinman's 2010 book "Delay Deny Defend: Why Insurance Companies Don't Pay Claims and What You Can Do About It," causing speculation that the shooter may have been referring to it.

The phrase "delay, deny, defend" is also common among lawyers who say that insurance companies delay the claims process with paperwork, deny claims that should be covered, and then defend themselves in court if a claimant pursues legal action.

The suspect of Thompson's shooting was still on the run as of Friday afternoon. Police haven't shared a motive behind the killing, which took place Wednesday morning.

Feinman, an author and professor emeritus at Rutgers, wrote about the insurance industry's evolution and shared advice for consumers on handling disputed claims in his book "Delay Deny Defend."

An NYPD spokesperson declined to comment when asked if police were investigating any link between the book and the shooting. The author also declined a request for comment.

Here are some of the key takeaways from Feinman's book.

There's only one mention of UnitedHealthcare by name.

While Feinman mentioned several top insurance companies by name throughout the book — State Farm and Allstate in particular — UnitedHealthcare only appeared once.

In the introduction, Feinman described how, in 2009, UnitedHealth, Aetna, Guardian, and other companies agreed to stop using certain databases to calculate fees for out-of-network treatment after being accused by then-New York Attorney General Andrew Cuomo of systematically lowballing patients.

Feinman says the insurance industry changed in the early 1990s.

In the intro to his book, Feinman wrote that insurance companies began to significantly reconsider the claims process in the 1990s when they "became a profit center rather than the place that kept the company's promise."

A major part of this shift occurred when insurance companies, including Allstate in 1992, hired consulting giant McKinsey & Company, he said.

McKinsey developed new strategies for handling claims and saw it as a "zero-sum game," Feinman writes. The insurance companies started using computer systems to estimate the amounts to be paid and deterring claimants from hiring lawyers, he said.

McKinsey declined Business Insider's request for comment.

Insurance companies aren't friends — but they're also not the enemy, he wrote.

Feinman said in the book that insurance companies aren't our friends — but they're not our enemies, either.

That's because companies must pay claims "pretty well most of the time" to stay in business.

"The point of view in this book is pro-consumer but it is not anti-insurance," Feinman writes. "Insurance is essential to our economic security." However, to serve as "the great protector of the standard of living of the American middle class, prompt and fair claim handling has to be the rule," he wrote.

'Understand your coverage. Understand the claims system. Get help if you need it.'

In Chapter 11, Feinman outlined what consumers can do to protect themselves while also seeking ways to cooperate with insurance companies.

He wrote that the responsibility to fix the system shouldn't fall to consumers alone. Legislators, regulators, and the courts must also step in, he wrote.

Feinman's advice boiled down to three key tenets: consumers should research the reputation of their agencies and policies carefully, understand the claims system, and seek legal recourse when necessary.

On Wednesday, moments after the news broke that Brian Thompson, the CEO of UnitedHealthcare, had been fatally shot in Midtown Manhattan, social media unleashed a barrage of caustic commentary about his death. In lieu of condolences, Americans from all walks of life shared barbed jokes, grim memes, and personal anecdotes about their own experiences with giant insurers like UnitedHealthcare.

On Facebook, UnitedHealthcare's statement about the murder of its chief executive elicited 46,000 reactions — 41,000 of which employed the laughing emoji. The company quickly turned off comments on the post, but hundreds of users shared it with arch commentary.

"The amount of laugh reacts on the original post speaks volumes lol," one user wrote.

"My thoughts & prayers were out of network," wrote another.

While the motive behind Thompson's murder remains unknown, the internet treated it as an occasion for ghoulish schadenfreude. America's health insurance system is so broken and cruel, people openly declared, that the death of one of its most powerful executives merited nothing but scorn and derision. "He was CEO when he was shot," read one tweet that received more than 120,000 likes. "Preexisting condition. Claim denied."

"The UnitedHealthcare CEO might be the most celebrated death on this app since Henry Kissinger," wrote another user on X.

Given the nature of social media, where the most provocative and emotion-laden commentary is engineered to rise to the top, it's not surprising that platforms from TikTok to Reddit would be filled with hateful invective. What's striking, however, is how the backlash revealed the depth of the bitterness toward health insurers. In the face of a man being gunned down in the street, people didn't keep their feelings toward insurers in check; rather, they seized on it as a moment to vent their rage. Everyone from right-wing influencers to tenured Ivy League professors responded to Thompson's killing by posting about what they saw as the injustices of America's health insurers. Even on LinkedIn, one of the internet's last bastions of civility and professionalism, hundreds of business executives, HR leaders, and tech managers shared deeply personal stories about how they and their loved ones had suffered at the hands of a healthcare bureaucracy that often delays and denies reasonable claims.

In one exchange, a hospital executive acknowledged that many Americans are fed up with health insurers. "As healthcare security professionals, we know that many see healthcare as a target for their anger," he wrote. "Family members who have lost a loved one may feel as though a physician, healthcare facility, or insurer is responsible for that loss."

Jill Christensen, a former vice president at Western Union, responded to the post by forcefully rejecting its wording. "In many instances, it's not feel, it's ARE responsible for that loss," she wrote. "I was diagnosed with Stage 4 cancer and UHC denied every claim. While today's event is tragic, it does not come as a surprise to the millions of people — like myself — who pay their OOP costs and premiums, only to be turned away at their greatest time of need."

The joking language of the internet has become a standard way for Americans to process tragic events, whether the September 11, 2001, attacks or the July 2024 assassination attempt on Donald Trump. But Thompson's murder sparked something different: an unparalleled public reckoning with one of the country's largest and most profitable industries. "When you shoot one man in the street it's murder," wrote one user on X. "When you kill thousands of people in hospitals by taking away their ability to get treatment you're an entrepreneur."

To some observers, the outpouring of ire also appeared to have an immediate effect on the industry itself. One day after Thompson's murder, Anthem Blue Cross Blue Shield announced that it was rescinding a controversial plan to limit coverage for anesthesia. "When patients become financially responsible because a health plan cuts how much they pay providers, that's what breeds all this anger," Marianne Udow-Phillips, a former Blue Cross executive, told Axios. An Anthem Blue Cross Blue Shield spokesperson told Business Insider, "It never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."

The storm of invective surrounding Thompson's killing will soon subside, as online malice always does. But it's also possible that the CEO's death will mark an inflection point in the debate over America's privatized system of health insurance. On X, one user drew a direct line between the callousness of the internet's response to Thompon's murder and an industry that makes it hard for many Americans to receive the medical treatment they need.

"All jokes aside," the user tweeted, "it's really fucked up to see so many people on here celebrating murder. No one here is the judge of who deserves to live or die. That's the job of the AI algorithm the insurance company designed to maximise profits on your health."

Scott Nover is a freelance writer based in Washington, DC. He is a contributing writer at Slate and was previously a staff writer at Quartz and Adweek covering media and technology.

Following the murder of its CEO on Wednesday morning, United Healthcare removed a page from its website listing the rest of its executive leadership, and several other health insurance companies have done the same, hiding the names and photos of their executives from easy public access. 

As of Thursday, United Healthcare’s “about us” page that listed leadership, including slain CEO Brian Thompson, redirects to the company’s homepage. An archive of the page shows that it was still up as of Wednesday morning, but is redirecting at the time of writing and isn’t directly accessible from Google search or the site’s navigation buttons. 

Anthem Blue Cross Blue Shield, which Thursday said it would walk back changes announced this week that would charge patients for anesthesia during procedures that went longer than estimated, now redirects its own leadership page to its “about us” page. Originally that page showed leadership, including President and CEO Kim Keck, Executive Vice President and CFO Christina Fisher, and 23 more executives as of earlier this year according to archives of the page, but is now inaccessible. 

• UnitedHealthcare CEO Brian Thompson was fatally shot Wednesday in New York City.
• The words "deny," "defend," and "depose" were found on shell casings at the scene, reports said.
• Officials are investigating whether the words are related to a motive.

Police found the words "deny," "defend," and "depose" on casings from bullets used to kill the UnitedHealthcare executive Brian Thompson on Wednesday in New York City, reports said.

The words were found on casings at the scene in Manhattan, and police are investigating whether they indicate that the motive for the crime was the insurance company's response to a claim, ABC News first reported.

Thompson's wife, Paulette, told NBC on Wednesday that he had spoken to her about receiving death threats she believed were related to a "lack of coverage."

"There have been some threats," she told the network. "Basically, I don't know, a lack of coverage? I don't know details. I just know that he said there were some people that had been threatening him."

A spokesperson for UnitedHealthcare did not immediately respond to requests for comment on a potential link between the shooting and a coverage-denial issue. Paulette Thompson couldn't be reached by BI for comment.

The words on the cases are similar to the title of a 2010 book, "Delay Deny Defend," which is subtitled, "Why Insurance Companies Don't Pay Claims and What You Can Do About It."

The author of the book, Jay M. Feinman, a legal professor who specializes in insurance law, torts, and contract law, declined a request for comment.

Police are still searching for the shooter. Authorities have described the killing as a "targeted attack."

Thompson was gunned down at about 6:45 a.m. outside the Hilton hotel in midtown Manhattan. The shooter fled the scene before police arrived.

UnitedHealthcare is the largest private insurer in the US, and Thompson was in New York for an investor meeting when he was killed.

The "investor day" event was then canceled.

• Baby boomers were hit the hardest by inflation in 2023, driven by rising healthcare costs.
• Healthcare costs outpaced overall inflation, and they make up a greater share of boomers' budgets compared to younger Americans.
• Gen X fared better due to different spending patterns.

Senior discounts might be particularly handy these days for America's retirees and older workers.

In 2023, those 65 and older experienced the highest inflation rates among age groups based on the items they buy, per an analysis from Wells Fargo economists. The analysis found that mounting healthcare costs, which have outpaced broader inflation, particularly weighed on baby boomers, who are aged 60 to 78. Simultaneously, older Americans did not spend as much on things like gas, where costs deflated.

It's not just healthcare that ate away at boomers' wallets. Business Insider analyzed data from the Bureau of Labor Statistics' annual consumer expenditures survey for 2023, and looked at how Americans 65 and older spent on different categories compared to all households.

Across all age groups, health insurance made up around 5% of annual spending in 2023; for Americans over 65, it was just over 9%. That's likely making a big dent in their finances, with health insurance prices rising nearly 7% year-over-year as of October 2024 per detailed consumer price index data from BLS, more than double the broader year-over-year inflation rate that month of 2.6%.

In addition to spending more on health insurance, Americans over 65 disproportionately spent on healthcare itself in 2023; they devoted 13.4% of their annual spending to healthcare, while Americans of all ages allocated just 8% of their spending on the same expenses. They also outspent other Americans on life and other personal insurance.

Other items those age 65 and up spent more of their incomes on than other age groups saw mounting inflation. For instance, older Americans devoted around 0.2% of their spending to postage — a small expense, but one where prices have grown by nearly 11% year-over-year.

We want to hear from you. Are you an older American with any financial regrets that you would be comfortable sharing with a reporter? Please fill out this quick form.

As boomers aged at home, they also spent a greater chunk of their annual expenditures on maintenance, repairs, insurance, and other expenses. Year-over-year, prices for the repair of household items grew by 5%.

Meanwhile, Gen X households have weathered inflation better than other generations. Wells Fargo's analysis showed that Americans ages 45 to 54 experienced 1.8% inflation year over year, while those 55 to 64 had 1.9% inflation. This is because Gen X, on the whole, spent less of their budgets on items with high price growth like housing and healthcare.

To be sure, a recent Gallup survey of 1,001 adults suggests Americans are doing well in retirement. Gallup found that three in four retirees said they could live comfortably off their savings, compared to less than half of nonretired Americans who expect to have enough for a comfortable retirement.

Still, even wealthier Americans told BI they've been hit hard by inflation.

Over 2,000 older Americans told BI their biggest regrets over the last few months in a voluntary, informal survey. An overwhelming majority said they're worried about their finances. A majority wished they had saved more or invested better for their retirement, as hundreds said they're still working or relying heavily on Social Security to get by.

Hundreds said health conditions, the death of a spouse, and job loss have contributed to less rosy finances. A few dozen said they weren't sure how much to save for retirement and spent too much shortly after retiring, hurting their wallets.

Many said they've cut back on experiences and more expensive purchases to focus on essential goods. Others said they've fallen through the cracks in the nation's social safety net, making too much for government assistance but not enough to feel comfortable.

Are you an older American with any financial regrets that you would be comfortable sharing with a reporter? Please fill out this quick form.

• Floridian homeowners face mounting uncertainties following hurricanes Helene and Milton.
• One resident is afraid of residents abandoning homes after storms if they can't pay to be fixed.
• An inland real-estate agent worries that some snowbirds won't return to buy new properties.

A destructive hurricane season has dealt a blow to Florida's housing market, which was already struggling with surging homeowners' association costs and a home insurance crisis.

In October, the five metropolitan areas nationwide with the biggest year-over-year drops in pending home sales were all located in the Sunshine State, according to a new report from real-estate site Redfin.

Over a four-week period ending November 10, pending home sales dropped 15.2% in Ft. Lauderdale, 14% in Miami, 13.8% in West Palm Beach, 9.5% in Jacksonville, and 7.2% in Tampa.

In Tampa, pending home sales actually fell as much as 32.2% during the month prior, when both Hurricanes Milton and Helene made landfall. The drop has leveled out at 7.2%, indicating the worst impacts may be over.

Pending home sales are deals where a contract is signed, but the sale has not closed. With a typical window of one to two months between the sales of homes and their closings, pending home sales can be an early indicator of market shifts.

Hurricanes Helene and Milton have exacerbated concerns about the future of property values and the cost of homeownership in Florida. After the storms, which made landfall in September and October, the state suffered an estimated $21 to $34 billion in damages, including uninsured properties.

At the same time, insurance experts have raised the alarm that an affordability crisis is likely to worsen. Some Florida cities, like Jacksonville and Cape Coral, saw average home insurance payments for mortgaged single-family residences jump at least 85% since 2019, according to financial services company Intercontinental Exchange.

"Florida represents an outsize amount of risk compared to other areas of the world," Kyle Ulrich, president and CEO of the Florida Association of Insurance Agents, told Business Insider in October.

For some residents, the mood on the ground is anxious.

Three Florida homeowners shared their concerns about the cost of rebuilding after hurricane damage, their home values, and the storms' impact on seasonal residents who are key drivers of the state economy.

Retirees couldn't afford to raise their home, then it was hit by a hurricane

In 2021, Jon and Lyn Drake purchased a home in Yankeetown, Florida, which is about two hours north of Tampa and less than 10 minutes from the shores of the Gulf of Mexico.

Their 800-square-foot house, located just feet away from a small riverbed, had belonged to a neighbor who died and cost them $190,000.

The dream home soon turned into a nightmare for the retired couple, aged 71 and 69. Last fall, Hurricane Idalia floodwaters reached within a foot of the house, the closest it had ever been, prompting Jon to look into services that could raise the home.

The Drakes said they were quoted prices to lift the house from around $130,000 to as high as $229,000, which they felt they couldn't afford.

"There's not a lot of companies that do it here, and it's just really price-gouging right now," Jon told BI.

Then Hurricane Helene barreled through Yankeetown. The couple lost their kitchen appliances, washer and dryer, and a new generator. The floors will have to be torn up.

For now, the couple is waiting to see how their insurance claims shake out to figure out their next steps. They want to rebuild, but are worried about how much of the cost they'll have to shoulder themselves.

"We're in a holding pattern right now," Jon said.

A coastal resident worries about his home value

John Adams, a retiree who lives near Yankeetown in Inglis, said his home was 15 inches away from taking on water during Hurricane Helene.

His home, raised 12 feet above ground, is the highest in his neighborhood, he said.

With the increasing power of storms coupled with skyrocketing insurance costs, Adams worries about homeowners in a pinch walking away from devastated homes. That could, in turn, lower the quality and value of the neighborhood. As Adam sees it, it's in his best interest to help pay for other peoples' homes to be raised.

"I'm in favor of paying for somebody else's fund to raise their homes. Because if we can solve that problem, it helps my values," he said.

Adams thinks either taxes could be raised or a new state agency could be created specifically to focus on raising low-lying homes that are most at risk. Currently, regional authorities like the Southwest Florida Water Management District are tasked with flood prevention and FEMA provides grants to some homeowners after a disaster.

"Nothing is ever going to fix or safeguard homes from flooding except 'elevate, elevate, elevate,'" he said "You can't outrun the water."

A real-estate agent thinks snowbirds could get scared away

In Ocala, located an hour from the Gulf of Mexico coastline, real-estate agent Emily White worries about how the severity of this year's storm will impact the snowbirds.

The annual migration of mostly elderly residents from cold-weather states who flock to the Florida sunshine to ride out the winter months plays a key role in the state's economy.

An estimated 1.5 million seasonal residents make up the snowbird flock, according to the Associated Press, representing a temporary 6.5% bump in the state's population.

"I'm praying the snowbirds come back this year. I need them to come back so I can get some of my listings sold, but we'll see how it's affected," White told Business Insider. "Will they come as hot and heavy as they did before these storms?"

White said a potential buyer from Arizona called her after seeing the devastation of Hurricane Milton, wondering if she might need to alter her plans to buy and how the storms would affect home-insurance costs.

Even if there's no immediate impact this winter, White expects the hurricane jitters to leave a lasting impact. Buyers who were looking at coastal properties might move more inland and some prospective buyers may choose to rent instead, she told BI.

"I think it'll deter people overall," White said.

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A few weeks ago in New Orleans, I boarded a flight headed for Austin, my hometown. A few minutes before our scheduled departure time, a gate agent came back on board to tell us our flight was over capacity, and asked for one volunteer who would be willing to stay overnight in exchange for a free hotel night and a $1,600 travel voucher. 

My hand was in the air before she finished her statement, and I quickly gathered my bags to follow her off the plane. After a lot of back and forth on the phone, agents at the gate rebooked me on a direct flight for the following day and gave me $2,500 in travel credit instead of the original $1,600. I'm not sure why they increased the offer amount, but I'm certainly not complaining.

I frequently travel alone, almost never check a bag, and usually plan ahead for travel delays, so I often have a lot of flexibility regarding when and how I get from Point A to Point B. I highly value future travel credit, and don't mind changing my plans last minute when my schedule allows for it.

This isn't the first time I've received travel credit in exchange for taking a later flight — and it happens more often than you might think. This summer, a woman received $3,550 in overbooked flight vouchers from American Airlines for staying three additional nights in Italy on the airline's dime. And in 2018, a traveler famously received a $10,000 United voucher in compensation for being bumped out of her basic economy seat. 

How to get travel credit or compensation for giving up your seat

Peak travel season often coincides with flight snafus from inclement weather or mechanical issues. As the holidays approach, you may find yourself in a similar situation to mine. If your schedule can accommodate a spontaneous change of plans, here's what you should know about volunteering for travel credit. 

Understanding bumping and denied boarding

Operating a commercial flight is expensive, so most airlines slightly oversell each flight to compensate for no-shows and last-minute cancellations. The complex logistics typically work out, and most travelers board the flights they book with no issues.

But from time to time, airlines end up with more passengers than available seats on a plane. In my case, for example, most of the travelers on my plane had been rebooked from a previous flight that was canceled due to storms in the area. 

When a flight has too many passengers, someone has to go, and the Department of Transportation (DoT) has strict regulations on how airlines must compensate affected customers. Aviation consumer protection guidelines state that airlines must first ask for volunteers before forcing anyone to give up their seats.

Travelers can negotiate compensation

Airlines can offer any amount of money or travel credit in exchange for the inconvenience, and travelers who volunteer their seats can negotiate with the airline for what they want. Whether you'll get what you want depends on how much the airline needs your seat — after all, the offer is open to all travelers until the airline's needs are met. 

The DoT recommends keeping the following questions in mind:

• What's the next available nonstop flight with a confirmed seat? If the next option available already has a full standby list, you may end up delayed again without further compensation. 
• Can the airline offer additional amenities such as free food, housing, and transit from the airport to the hotel?  
• If you receive a travel voucher instead of cash compensation, when does the credit expire? Does the credit have any blackout dates or restrictions on holiday or peak season travel? And can you use the credit for international trips or first-class tickets, or are you limited to economy-class fares?

Keep track of any expenses for future reimbursement 

You may still incur some expenses along the way, even if the airline has offered to cover your hotel and meals. In my situation, the airline gave me the wrong documents for my hotel voucher, which meant I had to pay for my own room upfront using one of my favorite credit cards with travel insurance and request money back after I got home. 

If you have checked bags, you may not see them for some time if you volunteer your seat since your luggage was probably loaded onto your original flight. You'll usually need to make do with what you already have with you, although you may be able to purchase small toiletries and necessities such as toothpaste and socks and claim reimbursement from the airline later on.

Many of the best travel rewards credit cards also offer trip delay benefits for incidentals when you're delayed on a flight you bought with the card. However, these perks may not apply if you voluntarily give up your seat, so check with the credit card company (or be willing to pay for your expenses out of pocket) before going on a shopping spree. 

Decide if the reward is worth the hassle

You should also consider your own situation before succumbing to the temptation of a four-figure travel voucher. If you need to be somewhere on time, there's no guarantee that another flight will get you to your destination by your personal deadline. 

It's also not a good idea to give up your seat if you're traveling with someone else, particularly if they are underage, elderly, or have special needs. Even if the airline compensates both of you for the loss of your seats, it may be hard to get on another flight where you can be seated together or enjoy the same benefits you would have had on your original flight.

You may be able to volunteer directly within the airline app

Asking for volunteers at the gate — or on the plane, like in my case — can be a time-consuming process, so some airlines have begun streamlining the process by contacting travelers directly. If you've ever checked in for a flight via the airline's app, you may have been invited to choose a different flight at no additional charge, or offered the chance to volunteer your seat at several different price points. 

If you're involuntarily denied boarding, here's what to know

In rare cases, you may be forced to give up your seat even if you don't volunteer. This is called involuntarily denied boarding, and airlines have a legal right to do so when seats are oversold. However, the airline must tell you why it is involuntarily denying you boarding and must provide a written statement explaining your rights and describing how it decides who will be bumped from the flight. In the example of the 2018 woman who received $10,000 from United, for example, she was bumped because she had the lowest-class fare among all of the travelers on the plane. 

You're not always eligible for compensation — but it doesn't hurt to ask

If you've been involuntarily denied boarding, you aren't automatically entitled to travel credit or a refund just because you've been removed from a flight. Airlines do not need to compensate travelers who are denied boarding due to safety, security, or health risks, or to passengers who engage in obscene, disruptive, or unlawful behavior. 

The DoT also doesn't require airlines to compensate travelers if they are denied boarding due to aircraft changes, weight and balance issues, or downgrades in fare class on flights departing from non-U.S. locations, charter flights, or small aircraft carrying 30 or fewer passengers. 

That being said, you can always contact the airline for compensation, even if they aren't mandated to reimburse you. The best way to do so is to contact the airline's customer service team after your travel is complete. You can typically find the right form under the "Contact Us" section of the airline's website. You'll get the fastest response if you include your date(s) of travel, flight number(s), full contact information, and airline frequent flyer number. I've personally gotten the best results by being extremely polite, concisely stating the facts, and asking for exactly what I want. 

I'm thrilled with the compensation I received, which is enough to allow me to see friends and family for free in months to come. If you have the misfortune of being on an oversold flight this season, consider the situation an opportunity to plan future adventures on your airline's dime.  

• Andre Nader switched from an EPO health insurance plan to an HDHP to get access to an HSA.
• Nader found the mental burden of managing healthcare costs outweighed HSA tax benefits.
• He plans to switch back to an EPO plan in 2025 for simplicity.

Andre Nader spent years on Meta's growth team, where his work involved experimentation and testing to determine how to improve specific products.

"I like to use that same testing methodology in my own life," the 37-year-old founder of financial independence blog FAANG FIRE told Business Insider. After getting laid off in 2023, Nader didn't have to job search thanks to the seven-figure net worth he built after years of investing in index funds and transitioned to writing on Substack full-time.

In 2024, he decided to put the popular, triple tax-advantaged health savings account (HSA) to the test. One requirement of using an HSA is that you must have a High Deductible Health Plan (HDHP), so he switched his family from an EPO health insurance plan, which he'd used for most of the past decade.

Nader said the EPO plan would be the simpler choice for him and his family — he wouldn't have to think about deductibles, the co-pays would be low, and all major hospitals were in-network — but he couldn't help but wonder if the savings from having an HSA would outweigh the extra hassle of having an HDHP, which offers a lower premium but comes with a higher deductible.

The benefits of using an HSA, which he describes as a "magical account," were obvious to him. It is a unicorn in that it offers a triple tax benefit:

1. You can contribute pretax dollars, which reduces your taxable income.
2. You can invest your HSA funds (the investment options vary by provider), and your contributions and earnings grow tax-free.
3. You can withdraw your money tax-free to cover qualified medical expenses (including things like copays, lab fees, and vaccines). After 65, you can use your HSA money to cover any expense without incurring a penalty, but the funds are subject to income tax.

Consider other tax-advantaged accounts. With a Roth IRA, you contribute after-tax money (and eventually withdraw it tax-free); with a traditional 401(k), you contribute pre-tax money (and eventually pay taxes when you withdraw).

"It's very rare to have an account where you're putting money in pre-tax and then also taking it out without paying taxes on it — and the entire time it's there, it can grow tax- and penalty-free," said Nader.

To maximize HSA gains, investors will invest their funds (rather than letting their HSA money sit in a cash account) and avoid touching it so it can grow and compound over time. Not touching your HSA funds means covering your medical expenses out of pocket, which is what Nader did throughout 2024. He saved all of his receipts from health-related expenses, so he'd have the option to reimburse himself later if he needed to (there's no time limit on when you can reimburse yourself from your HSA).

"In a spreadsheet, this is very lucrative," he said of taking full advantage of an HSA. Some companies will even contribute a certain amount to their employees' HSAs, which is essentially free money. "However, life isn't always about what happens in a spreadsheet."

Changing his coverage in 2025: 'I don't want to be living a life where I'm thinking about the cost of my healthcare'

As Nader's year of experimentation comes to a close, he's confident that an HDHP is not the right fit for his family and is switching healthcare plans in 2025. He says he'll likely go back to using an EPO.

"Even though the HSA is an amazing account that I can grow tax- and penalty-free forever, for me, the incremental benefit wasn't there," he said.

His main issue with using an HDHP and HSA was the mental bandwidth it required.

"The reason you're saving so much is you need to actually be thinking about your medical expenses more," said Nader. "Every single time that you go to urgent care, you're paying out of pocket until you hit a deductible or your out-of-pocket maximum. Every single time you go to a specialist, you're paying out-of-pocket until you hit your out-of-pocket maximum. So there was a lot more mental overhead in thinking about my healthcare decisions."

He felt like he couldn't be on autopilot like he was with an EPO plan, where an urgent care visit may cost him $10. With an HDHP, that same visit may cost hundreds of dollars, enough to stop and think about whether to get care.

"What's been happening over this year is, every single time I've needed to go to urgent care, I've thought about it a little bit, and I really didn't like that my health decisions were intersecting with my financial decisions," he said. "I didn't want to think about whether I should go to the emergency room if I had a cut; I should just go to the emergency room and not factor in the expenses."

At the end of the day, "I don't want to be living a life where I'm thinking about the cost of my healthcare."