Medicare Advantage PFFS (Private-Fee-for-Service) plans is a type of Medicare Advantage plan offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medicare Supplement plans. With a PFFS plan, the plan determines how much it will pay doctors, other healthcare providers and hospitals—and how much you must pay when you get care. PFFS generally have no network or a very small network. You can see any doctor who will bill the plan as long as they agree to the plan’s terms and conditions up front.
With Medicare Advantage PFFS plan, you agree to pay the plan’s monthly premiums, co-pays and coinsurance for medical services. The thing that makes these plans different from an HMO or PPO is that you are not limited to any certain network of providers.
When you present your Medicare Advantage PFFS plan ID card to any provider, before they treat you, the provider must agree to accept the plan’s payment terms and conditions and bill the plan.
Two main characteristics about Medicare Advantage PFFS:
- You can present your card to any Medicare-participating provider in the U.S. and ask if that the provider will treat you. Medicare Advantage PFFS plans are usually popular among Medicare recipients who travel frequently.
- Some Medicare Advantage PFFS plans allow you to have a separate Part D drug plan. You can choose a PFFS plan with a built-in drug plan or a PFFS plan for “medical only” and enroll in a separate drug plan
In the past, some people have confused PFFS plans with supplements. It is important you understand the following:
A Private Fee-for-service plan is NOT Medicare supplement insurance. Medical providers who do not contract with the plan are not required to treat you except in an emergency. You are responsible to discuss with any healthcare providers whether or not they agree to treat you and bill the plan.
Due to the rules about how to access providers, we strongly encourage you to contact us when researching your options. You need to fully understand how, where, and when you can use your coverage so that there are no surprises when you are seeking medical care.
At Nevada Medicare we go through a rigorous assessment and review of each plan. Our Medicare licensed agents can breakthrough the ever confusion and errors that happens frequently with Medicare recipients. We know this because we hear from folks like you everyday.
Let us do the hard work everyday, while you live and enjoy the more important aspects of your lifetime. Contact Us our help is free.