Medicare Advantage PFFS Plans

Private Fee-for-Service (PFFS) plans usually operate without a network of providers, leaving you to receive service from any healthcare provider who agrees to treat you and accepts your plan’s payment terms. These plans are especially helpful for people with a small variety of healthcare providers or who plan to spend a good deal of time beyond the limits of other plan networks (splitting time living in two homes, for instance). With a PFFS, you can expect to pay premiums, deductibles, copayments, and coinsurance.

Intro to PFFS

Private Fee-for-Service (PFFS) plans are one of the more unique Medicare Advantage plan types available. They offer flexibility to see any healthcare provider who agrees to treat you and agrees to the plan’s payment terms.

These plans have historically been more popular in rural areas, where plans with networks were more restrictive and healthcare providers are few and far between. A PFFS plan may be a good option for you if you maintain multiple residences or travel frequently throughout the country. The lack of network restrictions makes this plan a popular choice for free-range folks.

PFFS Coverage

PFFS plans are a type of Medicare Advantage plan, so they bring you the same coverage as Original Medicare does under Medicare Part A and Part B. This means you have hospital and medical coverage for inpatient care in a hospital or skilled nursing facility, hospice care, home health care, preventive care, and medically necessary care.

Your plan can also offer additional coverage for things not included in Part A and Part B, such as prescription drug coverage, dental care, vision care, hearing care, and more. Choosing to purchase these plans will result in additional monthly premiums.

PFFS Costs

For your PFFS plan, you will need to pay premiums, a yearly deductible, copayments, and coinsurance. These costs will vary between plans and be based on accepted fair costs for covered services. You must also continue to pay your monthly Medicare premiums for Part A and Part B while you are on a PFFS plan.

If your plan has a network, you will pay lower costs for receiving services from healthcare providers within your plan’s network. Seeing specialists or visiting the emergency room will result in higher out-of-pocket costs.

Plan Comparison

Unlike HMOs and PPOs, PFFS plans do not often have networks of healthcare providers. You can receive care from any healthcare provider who agrees to treat you and accepts your plan’s payment terms.

You do not need a primary care doctor and you do not need referrals to see a specialist. If your plan has a network and your current primary care doctor is not within the network, you can continue to see them.

To find out whether a PFFS plan is a good health insurance choice for you, or to learn more about the available Medicare Advantage plans in your area, call us toll free at 855-GO-AVILA or click the below button to request information.