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Term Definition

Drugs on a formulary are often organized into different drug "tiers," or groups of different drug types. Your cost depends on which drug tier your drug is in.

For example, a plan may form tiers this way:

  • Tier 1 - Generic drugs.
  • Tier 2 - Preferred brand-name drugs.
  • Tier 3- Non-preferred brand name drugs.

Contact the plan to learn more about its specific tier structure.

Timely Appeals Decision

A timely appeals decision is when a plan meets required Medicare timeframes for appeals. The specific timeframes required by Medicare are dependent on the type of appeal and may range between 24 hours to 7 days. Refer to your plan's explanation of coverage (EOC) for more details about the appeals process.

*NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is used with permission from Walter Feldesman, ESQ., Dictionary of Eldercare Terminology, Copyright 2000.

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