People
Patient playbook
Last reviewed · Educational use only
What to do before care, after care, and when a bill looks wrong.
Before a planned service
- Ask the office for the CPT or procedure code(s) and the facility where it will happen.
- Check that both the clinician and the facility are in network for your specific plan, not just "the insurance company". Ask about anesthesia, the lab and the radiologist too.
- Ask whether prior authorization is needed and who is getting it.
- Use your insurer's cost estimator, or ask the office for an estimate. If you are paying yourself, you are entitled to a Good Faith Estimate.
- Check your deductible and out-of-pocket status in the member portal.
When a bill looks wrong
- Wait for the EOB, then compare it to the bill using the EOB decoder.
- Ask the provider for an itemized bill with codes.
- If the service was an emergency, or an out-of-network clinician at an in-network hospital, check the No Surprises Act protections in networks. The federal help desk is listed under resources.
- If the plan denied it, appeal. Ask the office for help with records and a letter of medical necessity.
- Ask about financial assistance. Nonprofit hospitals must have a written financial assistance policy.
- Ask for a payment plan before a bill goes to collections. Keep notes of every call: date, name, reference number.
Enrollment windows
| Coverage | When you can enroll or change |
|---|---|
| Employer plans | Annual open enrollment set by the employer; within 30 days of a qualifying event (marriage, birth, adoption, loss of other coverage) |
| ACA Marketplace | For 2027 coverage, HealthCare.gov open enrollment runs November 1, 2026 to January 15, 2027; enroll by December 15 for coverage starting January 1. State-run exchanges can set different dates. Special enrollment within 60 days of a qualifying event. |
| Medicare | Initial enrollment: 7 months around your 65th birthday month. Annual election period October 15 – December 7. Medicare Advantage open enrollment January 1 – March 31. Late enrollment penalties can apply. |
| Medicaid / CHIP | Any time of year |
| COBRA | 60 days from the later of losing coverage or receiving the election notice |
Tax-advantaged accounts
| HSA | Health FSA | HRA | |
|---|---|---|---|
| Who owns it | You | Employer plan | Employer plan |
| Who funds it | You and/or employer | Mostly you (payroll) | Employer only |
| Needs a specific plan | Yes: HSA-qualified HDHP (and from 2026, bronze and catastrophic Marketplace plans) | No | No (rules vary by type) |
| Rolls over | Yes, forever; can invest | No, "use it or lose it" (limited carryover or grace period if offered) | Employer decides |
| Keeps it after leaving job | Yes | No | Usually no |
| Federal limit | 2026: $4,400 self / $8,750 family 2027: $4,500 / $9,000 | 2026: $3,400 2027: not yet announced | Employer sets |
Words that mean different things on the phone
- "Covered" means the plan recognizes the service. It does not mean free; you can still owe your full deductible.
- "We accept your insurance" can mean the office will file a claim, not that it is in network. Ask, "Are you in network with my plan?"
- "Pre-certified" or "authorized" means the plan agreed the service is necessary. It is not a promise to pay if eligibility or benefits change.