The Medicare & TFL Glossary

AEP (Oct 15 – Dec 7) is when you can join, switch, or drop MA plans. OEP (Jan 1 – Mar 31) lets you change MA plans once.

The Part A timeframe used to measure hospital deductibles and coinsurance — it resets after 60 days out of the hospital.

Other prescription coverage that's certified as good as or better than Medicare Part D — TRICARE Pharmacy qualifies.

The DoD's master database that determines who is eligible for TRICARE — including TRICARE For Life.

Optional dental and vision insurance retired military can buy through BENEFEDS — fills the dental/vision gap in Medicare and TFL.

The Jan 1 – Mar 31 window each year when you can sign up for Medicare if you missed your Initial Enrollment Period.

Two common Medicare Advantage plan structures — HMOs require in-network care, PPOs allow out-of-network at higher cost.

The 7-month window around your 65th birthday when you first sign up for Medicare without penalty.

An income-based surcharge added to your Medicare Part B and Part D premiums if your income exceeds CMS thresholds.

A 10% permanent surcharge on your Part B premium for every full 12-month period you delayed enrollment without qualifying coverage.

A provider's agreement to accept Medicare's approved amount as full payment.

The hospital insurance side of Original Medicare — covers inpatient stays, skilled nursing, hospice, and some home health.

The medical insurance side of Original Medicare — covers doctor visits, outpatient care, preventive services, and durable medical equipment.

An optional, all-in-one alternative way to get your Medicare benefits — delivered through a private plan instead of through Original Medicare.

Medicare's optional prescription drug coverage — almost always unnecessary if you have TRICARE For Life.

The DoD self-service portal where retirees verify and update DEERS, view TRICARE coverage, and request ID cards.

The yearly cap on what you'll spend on covered Medicare Advantage services — Original Medicare has no MOOP.

Once you're Medicare-eligible, you can only use MTFs (military hospitals/clinics) if they have unused capacity.

A Medicare Advantage plan benefit that reimburses part of your Part B premium, increasing your Social Security check.

An enrollment window triggered by qualifying life events — TRICARE does NOT trigger one.

Outside the U.S., TFL becomes the primary payer because Medicare generally doesn't pay overseas.

The wraparound secondary health coverage for Medicare-eligible military retirees, spouses, and survivors — no premium, no enrollment fee.

The DoD prescription drug benefit administered by Express Scripts — your drug coverage if you have TFL.

Separate care system run by the Department of Veterans Affairs for service-connected and enrolled veterans — does not coordinate with Medicare or TFL.

Wisconsin Physicians Service — the company that processes TRICARE For Life secondary claims.