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Medicare PFFS (Private-Fee-for-Service)
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Important Points
A Medicare Private-Fee-for-Service (PFFS) is a type of Medicare Advantage Plan
Medicare PFFS plans are available in select areas.
PFFS plans do not limit you to a certain network of providers.
PFFS stands for Private-Fee-for-Service and it is a certain kind of Medicare Advantage plan that is available in select areas.
Mohring Insurance Services LLC | Talk to a Medicare Expert at (866) 440-1885
What is a Medicare PFFS Plan?
A PFFS plan is a type of Medicare Advantage plan. It is not a Medicare Supplement plan.
When you join a Medicare PFFS plan, you agree to pay the plan's premiums as well as co-pays and coinsurance for medical services as they are outlined in the plan's Summary of Benefits. The key feature that makes these plans different from an HMO or PPO is that you are not limited to any specific network of providers.
With this type of plan, you would present your Medicare PFFS plan ID card to any doctor or provider BEFORE seeking medical care. Before treating you, the provider must agree to accept the plan's payment terms and conditions and bill the plan.
Common Features of PFFS Plans
You can present your plan ID card to any Medicare-participating provider in the U.S. and ask if they will treat you. For this reason, Medicare PFFS plans are popular with Medicare beneficiaries that travel frequently.
Some Medicare PFFS plans allow you to have a separate Part D prescription drug plan. You have the option to choose a PFFS plan with a built-in Part D prescription drug plan or opt for a PFFS plan for "medical only" and enroll in a separate stand-alone Part D plan.
Many people confuse a PFFS plan with a Medicare Supplement plan. It is important to understand:
A PFFS is NOT Medicare Supplement (Medigap) insurance. Providers who do not contract with the plan are not required to treat you except in the case of an emergency. This means that the responsibility is on you to discuss with any healthcare provider whether or not they will agree to see you and bill the PFFS plan.
More About Medicare PFFS Plans . . .
Due to the nature of the rules about how to access healthcare providers on a PFFS plan, it is important to work with a good insurance agent who specializes in Medicare products when researching your options. You must fully understand how, where, and when you can use your coverage so that there are no surprises when you are seeking medical care.
Mohring Insurance Services LLC has expert licensed insurance agents with a great deal of knowledge when it comes to PFFS plans. Claim your free consultation to ask about PFFS plans in your area today!
Key Points
You can visit any healthcare provider so long as they agree to accept your plan's payment terms and conditions.
With PFFS plans, you agree to pay the plan's premium, copays, and coinsurance.
PFFS plans are a type of Medicare Advantage plan. It is NOT a Medicare Supplement (Medigap) plan.
At Mohring Insurance Services LLC, we are happy to offer assistance with Medicare when you choose to enroll. Give us a call at (866) 440-1885, or to schedule a free consultation, click the link below:
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Rates are reviewed periodically and are subject to change in your state.
Cost Estimates are based on the information entered, using data about past experiences by beneficiaries with similar attributes and the premiums and benefits provided by the plan. Actual costs may vary. Monthly medical costs are represented by annual figures divided evenly per month.
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Medicare Supplement Plans are not connected with or endorsed by the U.S. Government or the federal Medicare program.
For plans that provide drug coverage, the formulary may change during the year.
Medicare beneficiaries may also enroll in Medicare plans through the CMS Medicare Online Enrollment Center located at https://www.medicare.gov.