What is a Medicare Advantage PFFS plan?
Below are the details about what a Medicare Advantage PFFS (Private Fee-for-Service) plan is:
- If you want to know how much health providers get paid, and how much you pay for a doctor’s visit. Then the Private Fee-for-Service plan decides the payment structure, not Medicare.
- As long as the Medicare-assigned provider accepts Private Fee-for-Service plan’s payment terms. Then you can see any provider you want in most cases.
All Original Medicare (Part A and Part B) benefits except hospice care will be included in your Medicare Advantage plans. You will also often get added benefits like prescription drug coverage with a Medicare Advantage plan. You will still be enrolled in the Medicare program even if you’re enrolled in a Medicare Advantage plan – like a PFFS plan.
Not all health care providers will accept Medicare Advantage PFFS plans. However, if your provider is incorporated with your PFFS plan’s network, then you may see that provider. Normally, you will be able to go to any Medicare-approved doctor that accepts PFFS plan’s payment terms if you choose to enroll in a PFFS plan. Also,you may be able to go out of your network if your Medicare Advantage PFFS plan lets you. This is usually for a higher cost though.
The chart below features some frequently asked questions and answers about PFFS plans:
| Will PFFS cover prescription drugs? | Sometimes. You can enroll in Medicare Part D Prescription Drug Plan if you want coverage and your Medicare Advantage PFFS plan doesn’t offer it |
|---|---|
| Will I have to choose a primary care doctor? | No. |
| Will I have to get a referral to see a specialist? | No. |
What you need to know before enrolling in a Medicare Advantage PFFS plan:
- You may not receive treatment from Out-of-network hospitals, doctors and other providers even if you’ve seen them before.
- You must make sure that your health care provider agrees to the PFFS plan’s payment terms. As well as treat you following the requirements of the PPFS plan. You require treatment by hospitals, doctors, and other providers if it is an emergency.
- You may pay more if you go to a hospital, doctor, or other provider that’s not in your PFFS plan’s network.
- You may be able to see a provider whom you’ve never seen before because they are in your PFFS plan’s network.
- The amount you pay for services is determined by your PFFS plan. Each plan varies from one another so it’s recommended to study your plan.
- Original Medicare (Part A and Part B) and Medicare supplement plans are different from Medicare Advantage PFFS plans.