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Private Fee for Service Plans - PFFS
What is a Private Fee for Service Plan?
A Private Fee For Service plan, or PFFS, is a type of Medicare Advantage plan offered by a health insurance company licensed by the state and has an annual contract with the Centers for Medicare & Medicaid Services to provide coverage for Medicare beneficiaries. An individual enrolled in a PFFS can go to any Medicare-approved doctor or hospital that accepts the plan's payment terms and agrees to treat you. However, not all health care providers will. In some PFFS that has a network, an individual may be able to go out-of-network for certain services usually, for a higher cost..
Covered Benefits under a Medicare Advantage PFFS
| Private Fee-for-Service (PFFS) Plan | |
| Are prescription drugs covered? | Sometimes. If your PFFS Plan doesn't offer drug coverage, you can join a Medicare Prescription Drug Plan to get coverage. |
| Do I need to choose a primary care doctor? | No. |
| Do I have to get a referral to see a specialist? | No. |
Things to Consider before enrolling in a Medicare Advantage Private Fee for Service Plan
- PFFS Plans aren't the same as Original Medicare or Medigap.
- The plan decides how much you pay for services.
- Some PFFS Plans contract with a network of providers who agree to always treat you even if you've never seen them before.
- If you join a PFFS Plan that has a network, you may pay more if you choose an out-of-network doctor, hospital, or other provider.
- Out-of-network doctors, hospitals, and other providers may decide not to treat you even if you've seen them before.
- For each service, make sure your doctors, hospitals, and other providers agree to treat you under the plan, and accept the plan's payment terms. In an emergency, doctors, hospitals, and other providers must treat you.
