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How it works

We separate general guidance, plan policy, member eligibility, network status, authorization, cost sharing, and claim payment, because they are not the same thing.

Prefer to watch? See what Covered does in two minutes.

  1. 1. Understand the question

    We normalize everyday language (typos, brand names, speech-like phrasing) and identify the service, drug, provider, or equipment, plus qualifiers like “screening” versus “for symptoms.”

  2. 2. Apply the rules for your kind of coverage

    A reviewed knowledge base covers 111 benefits across four plan families (job-based and Marketplace plans, Original Medicare, Medicare Advantage, and Medicaid), because the same service can be $0 under one and excluded under another.

  3. 3. Read your own plan, if you share it

    Upload your Summary of Benefits and Coverage and we extract its federally standardized table: deductible, out-of-pocket limit, every in- and out-of-network cost, and the exclusion list, each with page numbers. Answers then quote your plan first.

  4. 4. Gate every conclusion on evidence

    Every claim maps to an official source (HealthCare.gov, Medicare.gov, Medicaid.gov, USPSTF, Department of Labor) or to a page of your document. Ambiguous or conflicting evidence lowers the answer’s status instead of guessing.

  5. 5. Look up what it doesn't know

    Any prescription drug that isn't in the knowledge base is identified through the FDA's openFDA label database, including its class and whether a generic or biosimilar exists. Doctors and facilities come from the federal NPI Registry.

  6. 6. Turn it into action

    Estimate your cost, compare a year of costs across plans, check a bill against your EOB, draft a letter of medical necessity for your doctor, build an appeal with plan-specific deadlines, see what you may qualify for (Medicaid, CHIP, tax credits, Medicare savings programs), and work out when to sign up for Medicare and what a late penalty would cost.

What we can’t do (yet)

We don’t connect to your insurer’s eligibility systems, so we can’t see your live deductible balance, confirm a specific doctor’s network status, or guarantee a claim will be paid. The phone script on every answer covers exactly those gaps.