medicare glossary

a-z


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a b c d e f g h i l m o p q r s t u w

activities of daily living (ADL)

Activities of daily living refers to such activities as bathing, getting dressed, using toilet facilities, eating and moving place to place. Health professionals may gauge the functional status of an individual by their ability to perform ADLs.

administrative law judge (ALJ)

An administrative law judge is the officer of the court who presides over proceedings when a Medicare enrollee files an appeal, objecting to a Medicare decision or against a Medicare provider.

adult living care facility

An adult living care facility is a residential care facility that provides support for Medicare enrollees who can’t live by themselves but who don’t need skilled medical services 24 hours a day.

advance beneficiary notice (ABN)

An advanced beneficiary notice – also called a “waiver of liability” – is a notice that Medicare providers and suppliers are obligated to give to an Original Medicare enrollee when they find that Medicare does not cover the services the enrollee requests.

advance directive

An advance directive indicates the person designated to make medical decisions for you if you are unable physically or mentally to make those decisions yourself.

affiliated provider

An affiliated provider is a person or health care facility paid by your health care plan to provide service to you.

affordable care act (aca)

The Affordable Care Act (ACA) is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010. The legislation includes a long list of health-related provisions that began taking effect in 2010 and will “continue to be rolled out over the next four years.” Key provisions are intended to extend coverage to millions of uninsured Americans, to implement measures that will lower health care costs and improve system efficiency, and to eliminate industry practices that include rescission and denial of coverage due to pre-existing conditions.

aging in place

Aging in place refers to a decision individuals make to remain in their homes or their communities as they grow older instead of opting for relocation to long-term care facilities such as assisted living and nursing homes. The decision to remain independent and at home will likely involve consideration of in-home care provided by caregivers who can assist with individuals who might have difficulty with activities of daily living.

ambulatory care

Ambulatory care refers to health care services that do not include a stay in a hospital.

amyotrophic lateral sclerosis (ALS) or lou gehrig’s disease

Patients who suffer from amyotrophic lateral sclerosis (ALS) are eligible for Medicare at any age. The disease attacks a person’s motor nerve cells in the spinal cord.

ancillary services

A hospital or inpatient health care facility provides ancillary services (laboratory testing, X-rays, drugs, etc.).

annual coordinated election period (ACEP) or annual election period

Annual coordinated election period (ACEP) or annual election period refers to the period of time between November 15 and December 31 during which you can change your Medicare prescription drug coverage or your Original Medicare plan. ACEP is also the period of time during which you can enroll in Medicare Part D, if you missed your Initial Enrollment Period.

annual election period

Medicare’s annual election period – also known as Medicare open enrollment – is the annual period during which Medicare plan enrollees can reevaluate their coverage. During open enrollment, a beneficiary can switch Medicare Advantage plans, switch from Medicare Advantage to Original Medicare, join a Medicare prescription drug plan or drop Medicare Part D coverage entirely. In 2010, Medicare open enrollment starts November 15 and ends December 31.

appeal

An appeal is a formal request to Medicare to have an official decision reviewed in respect to a payment or policy you may wish to dispute.

assigned claim

An approved provider submits an assigned claim to Medicare for payment after you have received a service.

assistive technology

Individuals with disabilities use assistive technology devices to help them function. Medicare does not cover all assistive technologies, but does cover Closed Circuit Television (if a doctor determines it is medically necessary).

balance billing

Balance billing is a practice in which doctors or other health care providers bill you for charges that exceed the amount that will be reimbursed by Medicare for a particular service.

beneficiary

The beneficiary is enrolled in Medicare or Medicaid insurance and receives benefits through those policies.

beneficiary encrypted file

A beneficiary encrypted file requires your authorization before it can be read or used by health care professionals.

benefit period

Your benefit period begins the very day you enter a hospital for care or a skilled nursing facility. The benefit period ends when 60 days have passed since you last received either hospital care or care from a skilled nursing facility.

bereavement services

Families of Medicare enrollees who have passed away are entitled to bereavement services, including hospice counseling, up to a full year after the enrollee has died.

catastrophic coverage

Catastrophic coverage refers to the point when your total prescription drug costs for a calendar year have reached a maximum level of $5,451.25. At this point, you are out of the prescription drug “donut hole” and no longer have to pay 100 percent of your prescription drug expenses. At this point, your prescription drug coverage begins paying for most of your expenses, while you pay co-insurance or co-payment for covered costs through the end of the calendar year.

certificate of medical necessity (CMN)

A doctor must sign and submit a certificate of medical necessity before a Medicare enrollee can receive coverage for certain medical equipment.

claim

A claim is an application for benefits provided by your health plan. You must file a claim before funds will be reimbursed to your medical provider. A claim may be denied based on the carrier’s assessment of the circumstance.

coinsurance

Coinsurance refers to a percentage of the Medicare-approved cost of your health care services that you’re expected to pay after you’ve paid your plan deductibles.

copayment

Your copayment is a set out-of-pocket dollar amount you are obligated to pay for each medical service you receive, including visits to your doctor and prescriptions.

cost plans

A Medicare cost plan is similar to a Medicare HMO in that enrollees have access to a network of doctors and hospitals approved by Medicare. Unlike other Medicare HMO plans, however, a cost plan offers policy holders the option of receiving coverage outside of the network, in which case the Medicare-covered services are paid for through Original Medicare. Some cost plans may include prescription drug coverage. Enrollees can join a Medicare cost plan when it’s accepting new members, but may decide to return to Original Medicare at any time.

cost tiers

Medicare uses a system of cost tiers to rank prescription drugs according to their out-of-pocket cost to enrollees. Generic drugs are Tier 1 (cheapest), brand-name drugs are Tier 2, and specialty drugs are Tier 3 (the most expensive).

coverage gap

Under Medicare Part D prescription drug coverage, policy holders often encounter a coverage gap – or “donut hole” – the point where their prescription drug expenses exceed the initial coverage limit of their Part D coverage but have not yet reached the “catastrophic” level of coverage.

When enrollees reach the coverage gap, they begin paying 100 percent of their prescription drug costs out of pocket and continue until the “catastrophic” coverage level, at which point they being paying plan begins to pay most of their costs again through the remainder of the plan year.

critical access hospital

Critical access hospitals are typically located in rural areas and provide limited inpatient and outpatient services.

cross-over

A Medicare cross-over is a claim for a dual eligible – someone who is covered by both Medicare and Medicaid. The claims have been approved for payment by Medicare and then sent on to Medicaid, which then pays toward the Medicare deductible and coinsurance.

curative care

Curative care refers to health care practices that treat patients with the intent of curing them, not just reducing their pain or stress. An example is chemotherapy, which seeks to cure cancer patients.

custodial care

Medicare as a general policy does not cover custodial care (activities of daily living like getting in and out of bed, using the toilet facilities, getting dressed, etc.).

deductible

A deductible is an established out-of-pocket payment a Medicare enrollee must pay before his or her insurance begins taking over payment of the particular health care expense.

denial of coverage

Denial of coverage refers to a situation in which Medicare refuses to pay for certain medical services.

detailed explanation of non-coverage (denc)

When a provider – a home health agency, or skilled nursing facility, or other agency – determines you are no longer eligible for Medicare services, you will receive a detailed explanation of non-coverage.

detailed notice of discharge

A detailed notice of discharge provide a full explanation of the reasons for your hospital discharge and/or why services you are receiving are no longer covered by Medicare.

determination

Determination refers to a decision by Medicare to deny your claim, pay part of your claim or pay it in full.

disabled enrollee

A disabled enrollee is a person under 65 who qualifies for Medicare because of a disability, or is receiving benefits through Social Security or the Railroad Retirement system.

disenrollment

The process of discontinuing Medicare coverage.

donut hole

Medicare’s “donut hole” refers to the coverage gap in your Medicare Part D prescription drug benefit – the point where your prescription drug expenses exceed the initial coverage limit of your plan, but have not yet reached the catastrophic coverage level. When you reach this “donut hole,” you stop making a 25 percent copayment and begin paying 100 percent of your costs. You reach the catastrophic coverage level after you have paid $4,550 out of pocket, including your $310 deductible and copays. At that point, your plan kicks in again, paying most of your prescription drug expenses through the end of the year.

The Patient Protection and Affordable Care Act included a provision that provides relief for those who reach the “donut hole” by sending a tax-free $250 rebate to enrollees when they reach the coverage gap.

dual eligible

A person who is eligible for both Original Medicare and Medicaid is determined to be dual eligible.

durable medical equipment

Durable medical equipment is a class of Medicare-approved equipment authorized by an enrollee’s physician. Examples include wheelchairs, hospital beds, and oxygen equipment .

durable power of attorney

Durable power of attorney refers to your formal designation of a person to advocate on your behalf and make decisions about your personal affairs in the event you become unable to make decisions yourself.

eldercare

Eldercare refers to programs designed specifically to meet the needs of older individuals and includes Medicare, Social Security, private health insurance and other programs (housing, law, pensions, etc.).

end-stage renal disease (ESRD)

End-stage renal disease refers to the point when a person’s kidneys fail and the patient must either have a kidney transplant, or undergo dialysis treatments. Individuals with ESRD are automatically eligible for enrollment in Medicare.

enrollment period

The enrollment period is a window of time set by Medicare during which you can enroll in a Medicare health insurance plan. Each type of health plan has its own enrollment period.

exception request

If a prescription drug that you need is not on the approved list of prescription drugs, you can file a formal written exception request to Medicare, asking that the drug be approved or that the cost of the drug be lowered.

excess charges

For an Original Medicare enrollee, the excess charge is the difference between a doctor’s fee for service and what Medicare has approved as payment for that service.

expedited appeal

Medicare enrollee denied coverage for a claim may challenge that denial in an expedited appeal if the patient’s life or health is in serious jeopardy. Typically, an expedited appeal is resolved within 72 hours.

extra help

Individuals with limited income and resources and who have difficulty making their Medicare premium payments are, in some cases, eligible for financial assistance through the Extra Help program.

federal poverty level

In order to be eligible for Medicaid or Extra Help financial assistance, a U.S. citizen must prove that he or she is below the federal poverty level. The FPL, which changes annually, recognizes the level of income below which necessary services would be difficult to obtain.

federally qualified health center

A federally qualified health center is a community-based facility that offers comprehensive primary and preventive care to patients, regardless of their ability to pay for services. Facilities may include community centers or homeless shelters in “medically underserved areas” where individuals lack access to services.

fee-for-service

Fee-for-service is a system of health care payment in which a provider is paid separately for each particular service rendered. Original Medicare is an example of fee-for-service coverage.

fiscal intermediary

A fiscal intermediary is a private company contracted by Medicare to pay bills – such as hospital expenses – for Medicare Part A and Part B.

formulary

A formulary is the list of approved prescription drugs that Medicare will cover.

grievance

Enrollees in a Medicare health plan may file a grievance if they are unsatisfied with their treatment by those who administer their health plan. Conversely, an enrollee would file an appeal to complain about a treatment decision or service that is denied coverage.

guaranteed issue rights

Guaranteed issue rights – also known as “Medigap protections” – require insurance carriers by law to offer you a Medigap policy, prohibiting it from denying you coverage or charging you more for coverage based on reasons that include pre-existing conditions.

guaranteed renewable

Guaranteed renewable refers to a health plan in which the insurer is required to renew the policy if the policy holder has been consistently paid the policy premiums.

home health care

Home health care refers to care provided within a patient’s home either by health care professionals or by the patient’s family or friends. Medicare may cover home health care if it means certain conditions.

hospice care

Terminally ill patients may receive medical and support services through Medicare Part A from an approved hospice. Benefits may include pain-relief drugs. Terminally ill people receive Hospice care under Medicare Part A.

inpatient care

Inpatient care is medical treatment administered to a patient whose condition requires treatment in a hospital or other health care facility.

inpatient rehabilitation facility

An inpatient rehabilitation facility is a facility licensed under state laws to provide skilled nursing care and intensive rehabilitative services.

lifetime reserve days

If you need to remain hospitalized for more than 90 days in a single benefit period, Original Medicare will cover your costs for a total of 60 additional reserve days over the course of your lifetime. For each of these 60 lifetime reserve days, Medicare pays all covered costs minus the daily coinsurance amount.

limiting charge

When you receive care from a health care service provider who doesn’t accept Medicare, the most you can be charged is 15 percent over the approved amount for certain services. Limiting charges do not apply to equipment or medical supplies.

long-term care

Long-term care refers to both medical and non-medical care for patients with a chronic illness or disability. Care typically involves assisting patients with basic daily activities such as dressing, bathing and using the bathroom and may be provided at home or in facilities that include nursing homes and assisted living. Medicare, generally, will pay for medically necessary nursing home or home health care if recipients meet Medicare criteria. But Medicare usually doesn’t pay for long-term care that falls into the category of custodial care.

medicaid

Medicaid is the health care program for low-income individuals who can not otherwise afford Medicare or other commercial health insurance plans. The program is funded in part by the government and by the state in which the enrollee lives. What’s the difference between Medicare and Medicaid?

medical underwriting

Medical underwriting is a process used by insurance carrier to evaluate whether to accept an applicant for coverage or to determine the premium rate for the policy.

medically necessary

Medically necessary refers to services or supplies that are necessary for diagnosis or treatment of a medical condition.

medicare advantage

Medicare Advantage – or Medicare Part C – allows Medicare beneficiaries to receive Medicare-covered benefits through private health plans instead of through Original Medicare. Advantage plans often include additional benefits – beyond those included in Medicare Part A and Part B – such as prescription drug coverage. In exchange for the benefits, coverage may be limited to network of providers. An Advantage plan may be an HMO, PPO or private fee-for-service plan, but it must be approved by Medicare and follow its guidelines.

medicare advantage prescription drug plan (ma-pd)

A Medicare Advantage prescription drug plan (MA-PD) is an option for Medicare beneficiaries who want to enroll in Medicare Part D prescription drug coverage, which subsidizes the costs of prescription drugs. A Medicare Advantage prescription drug plan would offer Medicare Part A and Medicare Part B benefits within the same plan.

medicare cost plan

Medicare cost plan is similar to a Medicare HMO in that enrollees have access to a network of doctors and hospitals approved by Medicare. Unlike other Medicare HMO plans, however, a cost plan offers policy holders the option of receiving coverage outside of the network, in which case the Medicare-covered services are paid for through Original Medicare. Some cost plans may include prescription drug coverage. Enrollees can join a Medicare cost plan when it’s accepting new members, but may decide to return to Original Medicare at any time.

medicare open enrollment

Medicare open enrollment – also known as the annual election period or annual coordinated election period  – refers to the annual period during which Medicare plan enrollees can reevaluate their coverage – whether it’s Original Medicare, Medicare Advantage or a prescription drug plan through Medicare Part D. During Medicare open enrollment, a beneficiary can switch Medicare Advantage plans, switch from Medicare Advantage back to Original Medicare, join a Medicare prescription drug plan or drop Medicare Part D coverage entirely.

medicare part a

Medicare Part A or “hospital insurance”  covers inpatient care, including inpatient hospital stays (of at least one night), skilled nursing facility stays (if they meet criteria), home health care and hospice care. Find out how to enroll and what Medicare Part A costs.

medicare part b

Medicare Part B or ”medical insurance” covers medically necessary outpatient expenses, including physician and nursing fees, as well as a range of services (such as x-rays, diagnostic tests, some vaccinations and renal dialysis) and some equipment. Find out how to enroll and what Medicare Part B costs.

medicare part c (medicare advantage)

Medicare Part C – or Medicare Advantage – plans offer Medicare-covered benefits through private health plans instead of through Original Medicare. The plans often include benefits beyond those in Medicare Part A and Part B – such as prescription drug coverage . In exchange for the additional benefits, coverage may be limited to network of providers.

medicare part d

Medicare Part D is prescription drug coverage that subsidizes the costs of prescription drugs for Medicare beneficiaries. Medicare recipients select the coverage by enrolling in either a prescription drug plan (PDP) – which covers only prescription drugs – or a Medicare Advantage plan, which covers prescriptions and other medical expenses. Enrollees pay a co-pay for each prescription, a monthly premium and an annual deductible. Find out how to enroll and what Medicare Part D coverage costs.

medicare select

Medicare Select is a type of Medicare supplement (Medigap) plan sold in some states that can be any of the standardized Medigap plans (A-N) but which requires policy holder to receive services from within a defined network of hospitals and – in some cases – doctors in order to be eligible for full benefits.

medicare summary notice (msn)

After you’ve received health care services, you will receive a medicare summary notice explaining that the doctor you visited has requested reimbursement from Medicare. The MSN provides details about what you are charged for, what Medicare pays, and what you must pay.

medicare supplement insurance

Medicare supplement insurance plans – sold by private insurance companies – offer supplemental benefits to fill gaps in Original Medicare coverage. The plans – also known as Medigap – offer combinations of benefits, covering expenses ranging from copayments and deductibles to foreign travel emergency expenses and preventive care. Find out how to enroll and what Medigap coverage costs.

medigap

Medigap plans – sold by private insurance companies – offer supplemental benefits to fill gaps in Original Medicare coverage. The plans – also known as Medicare supplement insurance – offer combinations of benefits, covering expenses ranging from copayments and deductibles to foreign travel emergency expenses and preventive care. Find out how to enroll and what Medigap coverage costs.

medigap open enrollment period

You are eligible to enroll in a Medigap policy – without the possibility of being denied coverage – during the six months beginning the first month you turn 65 and you receive coverage under Medicare Part B. If you do not enroll during that initial window of opportunity, insurers have the right to deny you coverage.

medigap protections

Medigap protections – also known as “guaranteed issue rights” – require insurance carriers by law to offer you a Medigap policy, prohibiting the carrier from denying you coverage or charging you more for coverage based on reasons that include pre-existing conditions.

original medicare

Original Medicare – or “traditional Medicare” – is the fee-for-service program in which the government pays for health care costs you incur. The coverage – which includes Medicare Part A and Medicare Part B – allows you to see a doctor anywhere in the country (as long as the doctor treats Medicare patients).

outpatient hospital care

When you have been admitted into a hospital as an inpatient, but the hospital registers you as an outpatient, your medical or surgical care is considered as outpatient hospital care – even if you stay overnight in the hospital for observation purposes.

patient protection and affordable care act (ppaca)

The Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act (ACA) – is the landmark health reform legislation  signed into law by President Barack Obama in 2010. The legislation includes health-related provisions that began taking effect in 2010 and will “continue to be rolled out over the next four years.” Key provisions will extend coverage to millions of uninsured Americans, implement measures that will lower health care costs and improve system efficiency, and eliminate industry practices that include rescission and denial of coverage due to pre-existing conditions.

pre-existing condition

A pre-existing condition is a medical condition that is excluded from coverage by an insurance company because the condition was believed to exist prior to the individual obtaining coverage.

preferred provider organization

A preferred provider organization (PPO) is a Medicare Advantage plan which gives policy holders an incentive use the providers (doctors, hospitals) within the plan’s network of service providers. In return, the plan pays a higher percentage of your health care expenses.

prescription drug coverage

Prescription drug coverage – or Medicare Part D – subsidizes the costs of brand-name and generic prescription drugs for Medicare beneficiaries. Medicare recipients choose the coverage by enrolling in either a stand-alone prescription drug plan (PDP) – which covers only prescription drugs – or a Medicare Advantage plan, which covers prescriptions and other medical expenses.

Regardless of the plan, you’ll pay a co-pay for each prescription, a monthly premium – which will vary by plan – and an annual deductible. Individuals with limited income and resources may qualify for financial assistance.

prescription drug donut hole

Medicare’s “donut hole” refers to the coverage gap in your Medicare Part D prescription drug benefit – the point where your prescription drug expenses exceed the initial coverage limit of your plan, but have not yet reached the catastrophic coverage level.

When you reach this “donut hole,” you stop making a 25 percent co-payment and begin paying 100 percent of your costs. You reach the catastrophic coverage level after you have paid $4,550 out of pocket, including your $310 deductible and copays. At that point, your plan kicks in again, paying most of your prescription drug expenses through the end of the year.

The Patient Protection and Affordable Care Act included a provision that provides relief for those who reach the “donut hole” by sending a tax-free $250 rebate to enrollees when they reach the coverage gap.

prescription drug plan (PDP)

A prescription drug plan (PDP) is one option for individuals who want to enroll in the Medicare Part D prescription drug coverage, which subsidizes the costs of prescription drugs for enrollees. A prescription drug plan (PDP) is a stand-alone plan, covering only prescription drugs. Enrollees who choose the option of prescription drug coverage through a Medicare Advantage plan would also have coverage for other medical expenses as part of that plan.

Enrollees pay a co-pay for each prescription, a monthly premium and an annual deductible.

preventive services

Preventive services are provided to help you avoid becoming sick in the first place. Mammograms, flu shots, Pap tests and pelvic exams are examples of preventive services.

primary care doctor

Your primary care doctor is the physician you turn to first regarding any health care issue that may arise. If you need a specialist, you trust your primary care doctor to give you the best referral for that extra care.

private fee-for-service plan

Private fee-for-service plans are Medicare Advantage plans that allow you to receive care from any hospital or doctor that accepts the plan’s coverage. The plan does not have to follow Medicare guidelines, though, when it comes to paying for the services you receive. (It can cost more or less than Medicare). However, these plans often offer more coverage than Original Medicare.

programs of all-inclusive care for the elderly

Older adults and people over age 55 with disabilities may be eligible for programs of all-inclusive care for the elderly (PACE) – comprehensive care and services from a team of health care professionals using Medicare and Medicaid funds. PACE enrollees must be at least 55, live in the PACE service area, be certified as eligible by the state agency, and be healthy enough to live safely in the community.

quality improvement organization

A quality improvement organization is a team of doctors and health care professionals who keep track of the quality of care received by Medicare patients. These paid experts review and investigate complaints, and critique the decision-making policies of providers as well as the quality of facilities within the Medicare program.

referral

Managed care plans require that you get a referral from your primary care doctor prior to receiving health care services from any other physician or provider. If you do not get that referral first, plans in many instances will not pay for your care.

regional home health intermediary

A regional home health intermediary is a private company that contracted through Medicare to pay bills (hospice, home health care) under the guidelines of Original Medicare. RHHIs also investigate the quality of home health care services.

service area

Some services provided by your health plan may be limited to a defined service area. If you move out of the service area for some Medicare plans, you will automatically be disqualified from that plan.

silver sneakers

Silver Sneakers refers to the growing population of Baby Boomers and, in some cases, seniors over the age of 65. A growing number of health insurers offer “Silver Sneakers” Medicare Advantage plans, but “Silver Sneakers” also generally applies to a growing number of senior-focused programs ranging from fitness courses to workshops and  senior discounts.

skilled nursing

Skilled nursing care is care provided by a registered nurse or a licensed practical nurse and which may be covered by Medicare, Medicare, or other health plans.

skilled nursing facility

A skilled nursing facility provides the staff and equipment to administer skilled nursing care, rehabilitation services or other health care services.

social health maintenance organization

A social health maintenance organization is a health care insurance plan offering a complete range of coverage and benefits, including: personal care services, hearing aids, dental care, eyeglasses, prescription drug and chronic care benefits, short-term nursing home care and medical transportation services. An SHMO is more expensive, but enrollees are covered for far more services than Original Medicare.

special election period

A special election period is a set time period during which Medicare recipients can change their plan or return to Medicare. Reasons for the change of plan may include a move from the area covered by a recipient’s existing Medicare plan, a violation of policy terms by a plan provider or other reason approved by the Centers for Medicare and Medicaid Services.

special enrollment period

If you missed your first opportunity to sign up for Medicare Part B because you were still working (or your spouse was) at age 65 and were covered by an employer group health plan at that time, an eight-month special enrollment period begins the month after your job ends, or when your previous group health coverage ends – whichever happens first.

special needs plan (SNP)

A Medicare special needs plan (SNP) is a type of Medicare Advantage plan that provides all of the health care and services of Medicare Parts A and B to people who require special care for chronic illnesses, care management of multiple diseases, and focused care management. The plans may be limited to individuals in specific types of institutions – such as nursing homes – or beneficiaries who are dual eligibles or who have specific chronic or disabling conditions.

specified low-income medicare beneficiaries

Specified Low-Income Medicare Beneficiaries is a Medicaid program that will cover your Medicare Part B premiums if you have limited resources, an income below the poverty line, and are already receiving Medicare Part A.

state health insurance assistance program

The State Health Insurance Assistance Program is a national program that provides free counseling and assistance to Medicare enrollees and their families.

state medical assistance office

Through its state medical assistance office, each state provides services – including Medicaid – and helpful information to low-income citizens.

tricare for life (TFL)

Veterans of the Armed Services who are eligible for Medicare are entitled to expanded medical coverage through Tricare for Life. Their family members and survivors and – in some cases, former spouses – are also eligible for TFL benefits.

urgently needed care

If you’re enrolled in a Medicare plan other than Original Medicare, and you fall ill or need care immediately (but it is not life-threatening), your are entitled to coverage from your primary care doctor. If you are out of the service area of your plan and can not wait to return home to receive care, your health plan will pay for your urgently needed care.

waiting period

Under the terms of some health plans, potential enrollees must wait a defined period of time before they are eligible for enrollment and coverage.

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