Private Fee-For-Service (PFFS) Plans

Private Fee-For-Service (PFFS) Plans decide what they will pay doctors and what you will pay for health care services.

A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. It’s different than Original Medicare or Medigap.  You have to pay your Medicare Part B premium and possibly an additional premium to belong. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

You can go doctors and hospitals that accept your plan’s payment terms.

In a PFFS plan you can go to any Medicare-approved doctor, health care provider, or hospital that accepts the plan’s payment terms and agrees to treat you.  Not all providers will. If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. If you choose an out of network provider, you may pay more.

PFFS Plans often cover prescription drugs.

However If your PFFS Plan doesn’t offer drug coverage, you can join a Medicare Prescription Drug Plan to get coverage.

You don’t need to choose a primary care doctor or get referrals to see a specialist.

Some PFFS Plans have a network of providers who agree to always treat you even if you’ve never seen them before.  Out-of-network providers may decide not to treat you even if you’ve seen them before, but if they do make sure they agree to accept the plan’s payment terms.  You cannot be denied treatment in an emergency. You only have to pay the copayment allowed by the plan for the type(s) of service you get at the time of the service.  If you think a PFFS Plan sounds like it might be right for you, call for a quote today