Glossary
Limiting Charge
The maximum a non-participating Medicare provider may charge — 115% of the Medicare non-PAR approved amount.
Quick answer
Federal law caps what a non-participating Medicare provider can charge at 115% of the (already reduced) non-PAR approved amount. This cap is the 'limiting charge.' Opt-out providers are NOT bound by it.
Why it matters
The limiting charge is the legal ceiling protecting Medicare beneficiaries from runaway billing at non-PAR providers. TFL, in turn, picks up the excess up to TRICARE rates.
When you'll encounter it
Any time you see a non-PAR provider.
Impact on Medicare
Limits what the provider can collect from you above Medicare's payment.
Impact on TRICARE For Life
TFL pays the limiting-charge difference as secondary, neutralizing the extra cost.
Common misconceptions
- "The limiting charge applies to all doctors." — Only non-PAR providers. PAR providers can't bill above the approved amount; opt-out providers aren't restricted at all.
Common mistakes to avoid
- Paying the limiting charge out-of-pocket instead of letting TFL process it.
Real-world scenario: Office visit. PAR approved amount = $100. Non-PAR approved = $95. Limiting charge = $109.25.
Medicare pays $76 (80% of $95). The patient is responsible for the $33.25 difference — TFL pays it.
What should I do?
- 1Verify non-PAR vs opt-out before any first visit.
- 2Never sign a 'private contract' — it waives Medicare and TFL.
- 3If billed above the limiting charge, the provider has violated federal law — call 1-800-MEDICARE.
Questions people commonly ask
Continue learning
— suggested by the knowledge graph- What is Medicare? A complete overview for retired militaryA plain-English, handbook-grounded overview of the federal health insurance program for people 65 and older, written specifically for retired service members and their families.
- Understanding Original Medicare (Parts A & B) for veteransExactly what Part A and Part B cover, what they cost in 2026, and why both are required to keep TRICARE For Life.
- Enrolling in Medicare: timing, methods, and the military-specific rulesWhen and how to sign up for Medicare Parts A and B — and the timing that protects your TRICARE For Life activation.
- Benefit Period (Part A)The Part A timeframe used to measure hospital deductibles and coinsurance — it resets after 60 days out of the hospital.
- Durable Medical Equipment (DME)Medically necessary, reusable equipment for home use — covered by Part B at 80% after the deductible.
- IRMAA (Income-Related Monthly Adjustment Amount)An income-based surcharge added to your Medicare Part B and Part D premiums when your modified adjusted gross income exceeds CMS thresholds.
- Late Enrollment Penalty (Part B and Part D)A permanent monthly surcharge added to your Part B (10% per 12 months delayed) or Part D (1% per month delayed) premium for as long as you have Medicare.
- Medicare Savings Programs (MSPs)State-administered programs that help pay Part B premiums (and sometimes deductibles and copays) for beneficiaries with limited income — including QMB, SLMB, QI, and QDWI.
- Medicare-Participating ProviderA provider who has signed an agreement to always accept Medicare assignment for every covered service.
- How much does Medicare Part B cost?Most people pay the standard Part B premium (roughly $185/month in 2026). Higher-income retirees pay IRMAA on top. Lower-income retirees may qualify for help paying it.
- I'm turning 65. What should I do first?About 3 months before your 65th birthday, sign up for Medicare Parts A and B at SSA.gov. TRICARE For Life activates automatically once both are effective and DEERS is current.
- Do I need Medicare Part A if I have TRICARE?Yes. TFL requires Part A and Part B. Part A is typically premium-free if you or your spouse worked 40+ quarters paying Medicare taxes.
- I missed my Medicare enrollment window. Now what?Use the General Enrollment Period (Jan 1 – Mar 31). You'll likely owe a Part B late penalty for life, and you'll have no TFL until Part B is effective.
- Can I take Part A now and add Part B later?You can — but for TFL purposes, that's the same as not enrolling. TFL requires both A and B simultaneously. Without B, TFL is suspended.
Related glossary terms
Related Official Resources
Continue learning straight from the source. Every link below goes to an official government or DoD resource.
Last reviewed January 2026 against the 2026 Medicare & You and TRICARE For Life handbooks.