Official resources
Last reviewed · Educational use only
Primary sources for rules and the current year's figures. Links open the official site in a new tab.
Patients and families
- HealthCare.gov: Marketplace plans, glossary, enrollment dates
- CMS No Surprises: surprise billing rights and complaints
- Medicare.gov: coverage, costs, plan finder
- Medicaid.gov: Medicaid and CHIP by state
- Department of Labor, EBSA: employer plans, COBRA, ERISA appeals
- NAIC state insurance departments: help with insured plans
Billing and coding
- X12 code lists: CARC, RARC, claim status codes
- Medicare Physician Fee Schedule
- Medicare Coverage Database: NCDs and LCDs
- PECOS: Medicare enrollment
- NPPES: NPI registry
- CAQH ProView: credentialing profile
- CMS ABN form and instructions
Annual figures
- IRS Publication 969: HSA, FSA, HRA rules and limits
- HealthCare.gov out-of-pocket limits
- Medicare costs: premiums and deductibles
- CMS CCIIO: Marketplace and private insurance rules
Disclosure
This guide is for educational purposes only.
- All example values are made up. Every plan, premium, deductible, coinsurance rate, charge, allowed amount, claim, EOB, member, provider and company shown in the examples, scenarios and tools is fictional, created to illustrate how the math works.
- No real policies are shown. Nothing here represents an actual insurance policy, plan, fee schedule or contract offered by any insurer, employer, government program or provider today.
- Plan structures are modeled on public information. How HMOs, PPOs, deductibles, networks, coordination of benefits and claims generally work follows publicly available sources such as HealthCare.gov, CMS, the IRS, the Department of Labor and the X12 code lists.
- Federal limits are cited, not invented. The annual federal figures in the tables (out-of-pocket limits, HSA and FSA limits, Medicare amounts) come from published government announcements as of November 2026. They change every year; confirm them with the sources above.
- Not advice. Nothing here is legal, tax, medical, coding, billing or financial advice, and it is no guarantee of coverage or payment. The plan's own documents, state law and provider contracts decide how a real claim is paid.
About this guide
Free to use, no account, no tracking, and no data leaves the page: every calculator runs in your browser and nothing you type is stored. It describes federal rules and common industry practice; state law, the plan document, and provider contracts can change the answer for a particular claim.
Educational content only. Not legal, tax, medical, coding, or financial advice. CPT is a registered trademark of the American Medical Association; CDT of the American Dental Association. Code descriptions are paraphrased. Federal amounts were checked against public announcements in November 2026; verify current figures with the sources above.