Glossary
Non-Participating Provider
A provider who treats Medicare patients but has not agreed to always accept assignment — and may charge up to 15% above Medicare's approved amount.
Also known as: non-PAR provider
Quick answer
A non-participating (non-PAR) provider still files Medicare claims but reserves the right to charge a 'limiting charge' — up to 115% of the reduced non-PAR approved amount — on any given claim. Importantly, non-PAR is NOT the same as opt-out.
Why it matters
TFL still pays as secondary at non-PAR providers, including the limiting charge, so your out-of-pocket usually remains $0 — but the claim takes longer to settle.
Why this matters at age 65
Many concierge and specialty practices are non-PAR. Knowing the difference between non-PAR and opt-out tells you whether TFL will rescue you or leave you with the full bill.
When you'll encounter it
Specialty care, smaller private practices, and some imaging centers.
Impact on Medicare
Medicare pays 80% of a slightly reduced approved amount (~95% of PAR).
Impact on TRICARE For Life
TFL pays the Medicare cost share AND the limiting charge difference — usually bringing patient cost to $0.
Impact on Medicare Advantage
Irrelevant on MA; network status is what matters.
Common misconceptions
- "Non-PAR means the doctor doesn't take Medicare." — They do — they just don't always accept assignment.
- "I'll owe the 15% limiting charge." — Not with TFL — TFL covers that excess up to TRICARE limits.
Common mistakes to avoid
- Confusing non-PAR with opt-out and paying the full bill out-of-pocket.
Real-world scenario: A dermatologist is non-PAR. Medicare's non-PAR approved amount is $180.50. The doctor charges the limiting charge of $207.58.
Medicare pays 80% of $180.50 = $144.40. TFL pays the rest ($63.18). Patient owes $0.
What should I do?
- 1Confirm non-PAR (not opt-out) before booking.
- 2Provide both Medicare and TFL cards at check-in.
- 3Watch for higher-than-expected provider bills and verify against the TFL EOB.
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.
- How Medicare and TRICARE For Life work togetherThe exact mechanics of who pays first, who pays second, and what you owe — for every common care scenario.
- Benefit Period (Part A)The Part A timeframe used to measure hospital deductibles and coinsurance — it resets after 60 days out of the hospital.
- Coordination of Benefits (COB)The federal and contractual rules that determine which insurer pays first when you have more than one health plan.
- 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.
- 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.
- Who pays first, Medicare or TRICARE For Life?Medicare pays first for any service it covers. TFL pays second. The claim usually crosses over automatically — you should never pay out of pocket up front.
- 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.
- How long does Medicare enrollment take to process?Most online applications are approved in 1–3 weeks. SSA mails the Medicare card within about 30 days of approval.
- How does the Medicare-to-TFL claim crossover work?Medicare processes the claim, pays its share, and electronically forwards it to WPS using your sponsor SSN. WPS pays TFL's share directly to the provider — usually within 2–3 weeks.
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.