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Please note that the definitions included in this Glossary reflect the manner in which these terms are used on Medicare in general.

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When someone uses your personal information without your permission to perpetrate fraudulent crimes.
A provider or facility that has a contract with a health plan for treatment or services. You will often pay less if you use healthcare professionals who are part of your Medicare Advantage Plan’s network. In-network providers may also be referred as a “participating provider” with the plan or a “preferred provider”.
An amount of money, you might have to pay in addition to your Part B or Part D premium if your income exceeds a certain annual threshold. Based on the income you reported on your IRS tax return from two years prior, the Social Security Administration (SSA) decides whether you owe an IRMAA.
A third party with which Medicare has a contract to manage second level appeals for coverage under a Medicare Advantage Plan or Part D plan.
A person who does not directly bear professional responsibility or personal gain for a claim or service being examined, providing a neutral and unbiased assessment.
A primary health care provider for the American Indian/Alaska Native Medicare population. IHS is in charge of offering Alaska Natives and members of federally recognized Native American Tribes direct medical and public health services.
A private health insurance policy that covers a single person rather than a group (such as a group of employees covered by an employer group health plan).


This glossary explains terms in the Medicare program, but it isn't a legal document. The official Medicare program provisions are found in the relevant laws, regulations, and rulings.

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