PFFS Plans
Private Fee-For-Service (PFFS) is a type of Medicare Advantage plan that has a contracted network of providers, and any provider who agrees to your plan’s terms.
Medicare Advantage and PFFS Plans
As a type of Medicare Advantage plan, PFFS plans work to lower the cost of your healthcare coverage. They’re offered by private insurance companies, so costs and benefits will vary. It’s important to compare plans in your area before committing to one.
PFFS plans are one of the most flexible options in terms of what providers they cover. These plans determine how much they will pay doctors, other health care providers, and hospitals, as well as how much you must pay when you get care. It’s more of a case-by-case basis rather than an established network.
What Else You Should Know
Technically, you can receive care from any doctor, hospital, medical office, etc. However, there are some conditions they have to accept for you to receive coverage, and not all providers will agree:
- Must be a Medicare-approved doctor, healthcare provider, or hospital
- Accept the plan’s payment terms
- Agree to treat you, and hasn’t opted out of Medicare
While PFFS plans don’t have a set network, there will likely be providers who have already agreed to always treat members of your plan. If your coverage isn’t accepted, any non-emergency or non-urgent care services may only be covered very little, or not at all.
What PFFS Covers
The main goal of PFFS plans is to reduce the costs of your Original Medicare coverage. So, by law, they must cover all of the same benefits as Part A and Part B, which include short-term hospital and nursing home care, as well as general medical needs for treatment and preventative care.
You may be able to find a PFFS plan that also covers additional benefits, such as:
- Limited dental, vision, and hearing
- Prescription drugs
- And more!
Plan Your Retirement with the Right Help
Whether it’s PFFS or anything dealing with Medicare, we can help. Call Priority Health Insurance Services at 626-966-1098, or email info@priorityhealthins.com.
