Your doctor orders an MRI. You call to schedule and get told it's pending authorization. Days pass. Nobody seems to be able to tell you where in the process it is, and you're still in pain. Prior authorization is one of the most frustrating parts of modern insurance, partly because it happens to you but not with you. Understanding the mechanics gives you something to do besides wait. What It Is Prior authorization is a requirement that your insurer approve certain care in adv

The pharmacist reads the screen, pauses, and says the number out loud like it's a question. Four hundred and something for a medication that cost you fifteen dollars last month. Nothing changed about your health. Something changed about your plan's formulary, or you switched plans, or a drug moved tiers at the start of the year. What a Formulary Is A formulary is the list of drugs your plan covers and how it prices them. Every plan has one, it's public, and it changes at leas

You looked the doctor up in your insurer's directory or online. It said in-network. You went. The bill says out-of-network. This happens constantly, and the reason is unglamorous: provider directories are frequently out of date. Doctors leave practices, practices drop contracts, and networks change faster than the databases behind them. Studies of directory accuracy keep finding error rates that would be unacceptable in almost any other consumer-facing system. The fix is a th

You go in for a free annual physical. Three weeks later there's a $340 bill. Nothing was miscoded, nobody made an error, and the visit really was covered. You just crossed a line during the appointment that changed what kind of visit it was. Preventive care is one of the best deals in your plan, and one of the easiest to accidentally lose. What "Free" Actually Covers Most non-grandfathered health plans have to cover a defined set of preventive services with no cost sharing wh

They sound like the same thing. Three letters, tax savings, health expenses. People use the terms interchangeably and then find out in December that one of them has a deadline and the other doesn't. They're built on opposite ideas. One is a savings account you own. The other is a spending arrangement your employer runs. The Health Savings Account An HSA is yours. You open it, you own it, and it follows you between jobs, into unemployment, and into retirement. To contribute, y

Around your 64th birthday, the mail starts. Glossy envelopes, urgent-sounding deadlines, a phone that rings more than it used to. All of it is trying to sell you something before you understand what you're buying. Medicare isn't as complicated as the mail makes it look. There are four parts, two roads, and a handful of deadlines that carry real penalties. Here's the whole picture. The Four Parts Part A is hospital insurance. Inpatient hospital stays, skilled nursing after a h

Nobody sends you a warning letter. You turn 26, and at some point that year the health plan you've been on since you were a kid stops covering you. Plenty of people find out when a pharmacy declines their card. The good news is this is one of the most predictable transitions in health insurance. You know the date years in advance. Here's how to use it. When Coverage Actually Ends The Affordable Care Act lets you stay on a parent's plan until you turn 26. What it doesn't do is

The Marketplace asks you to predict next year's income before next year has happened. Then it hands you a discount based on that guess. Most people type a number, take the discount, and don't think about it again until a tax form shows up with a surprise on it. The subsidy system is not complicated once you see the shape of it. But the consequences of a bad estimate changed recently, and they're less forgiving than they used to be. What the Premium Tax Credit Actually Is The

The metal tiers sound like a quality ranking. Platinum must be the good one and bronze must be the cheap one you settle for. That's not what they measure at all, and believing it is how people end up in the wrong plan. Metals measure one thing: how the bill gets split between you and the insurer, on average, across everyone in the plan. They say nothing about doctor quality, network size, or customer service. What Each Tier Actually Splits Roughly speaking, bronze plans pick