Private Fee For Service

Private-Fee-For-Service (PFFS) Medicare Advantage plans are a unique plan that are offered by private insurance companies. These plans are different from Original Medicare plans and may have different rules. This is what you need to know about the costs and benefits of PFFS Medicare plans.

How Do Medicare Advantage Plans Work?

Medicare Advantage plans are health care insurance plans that are supplied by private insurance companies who have contracted with Medicare to administer Original Medicare benefits. Each insurance company can choose what types of plans they wish to offer, and there are a range of options on the market currently. PFFS plans are only one option currently available, with HMO and PPO being two of the others.

What Is A Private Fee-For-Service Plan?

With a PFFS plan, your insurance provider sets predetermined rates that they will pay doctors and other health care providers for services that their plan’s participants receive. Therefore, your insurance company will negotiate with health care providers to convince them to accept their listed rates. If a medical professional accepts the terms of your plan, your treatment is covered, even if they are not members of your plan’s network. Still, health care costs are typically lower if you receive treatment strictly within the network.

PFFS Plan Rules

You do not need a primary care doctor to see a specialist when enrolled in a PFFS plan. Some PFFS plans have a network of providers that have agreed to see any plan member, even if they’ve never seen that patient before. If a doctor or other health care provider decides they do not want to treat you they have the freedom to not do so. Though, if a provider does agree to treat you, make sure that they have also accepted the payment terms offered by your insurance provider. If you are hurt in an emergency, health care professionals must administer treatment to you, regardless of whether they’ve accepted your plan’s terms.

PFFS Plan Costs

The typical PPFS plan requires you to pay a Part B premium and a Part C (Advantage) premium. You will also need to pay coinsurance, copayments, and deductibles depending on the nature of your policy. To lower costs, seek treatment solely within your plan’s network.

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PFFS Plan Enrollment

The best time to enroll in a PFFS plan is during the Initial Enrollment Period. This period begins three months before your 65th birthday, includes your birthday month, and continues for another three months. During this period, you have more flexibility in how you can enroll and will avoid late enrollment penalties if you do enroll during this period. If you miss your Initial Enrollment Period, you can still enroll in a PFFS plan during the Medicare Advantage Open Enrollment Period, which falls between January 1st and March 31st. There is also the Fall Open Enrollment Period which falls between October 15 and December 7.