Understanding Private Fee-for-Service (PFFS) Plans
What is a PFFS Plan?
A Private Fee-for-Service (PFFS) plan is a type of Medicare Advantage Plan offered by private insurance companies. It works differently from other Medicare plans. Understanding Private Fee-for-Service plans helps you compare your Medicare Advantage options more clearly.
Key Features of PFFS Plans
Freedom to Choose Providers: You are not limited to a network. You can visit any Medicare-approved provider who accepts the plan’s payment terms.
No Need for a Primary Doctor or Referrals
You do not need to choose a primary care physician (PCP), and referrals are not required to see specialists.
Pre-Set Costs
The plan sets how much it pays providers and what your share of the cost is. These amounts may be different from other plans.
Emergency and Urgent Care may be covered.
Whether you are in or out of the plan’s service area, emergency and urgent care services may be covered.
Additional Benefits May Be Included
Some PFFS plans may include benefits like vision, dental, hearing, or wellness programs. Some PFFS plans might offer benefits such as vision, dental, hearing, or wellness programs.
When are you eligible for a Medicare Advantage plan?
- If you’re 65 or older
- If you have other Medicare coverage, you can change to Medicare Advantage during annual open enrollment
- You may also qualify under other exceptions, such as an eligible disability or chronic condition
How a PFFS Plan Works
You receive a plan ID card to use when receiving services.
Before each visit, your provider must agree to treat you and accept the plan’s payment terms. Some plans may include a provider network. If they do, using in-network providers may save you money.
Things to Keep in Mind
Providers can choose on a visit-by-visit basis whether to accept your plan.
You may be responsible for cost-sharing amounts like copayments or coinsurance.
Monthly premiums, deductibles, and service areas vary by plan.
Is a PFFS Plan Right for You?
A PFFS plan may be a good fit if you:
- Want more freedom to choose your doctors and hospitals.
- Prefer not to have a primary care doctor or need referrals.
- Are looking for plans that may include extra benefits beyond Original Medicare.
Learn More, Choose Confidently
Explore all your Medicare coverage options and make the choice that’s best for your health and budget. If you want help understanding Private Fee-for-Service plans compared to other Medicare Advantage options, a Licensed Sales Agent can guide you through the details.
Have questions about your Medicare coverage options? Speak to a Licensed Sales Agent who can explain how PFFS plans work and help you find one that fits your needs.
Explore Medicare Resources
Check out these topics for helpful Medicare information. You can also visit official resources for more trusted details.