What is a PFFS?

Private fee-for-service (PFFS) plans are Medicare Advantage (Part C) plans you can enroll in as a different way to receive your Medicare benefits. PFFS plans must cover all services a patient would receive under Original Medicare Part A & Part B. This includes both inpatient services (Part A) and outpatient services (Part B).

Private fee-for-service (PFFS) plans may offer Medicare prescription drug coverage (Part D), but this is not a requirement for a PFFS plan. If a private fee-for-service plan does not provide drug coverage, you may join a stand-alone Medicare Part D Prescription Drug Plan to get your prescription drugs. PFFS plans may also choose to include benefits that Original Medicare Part A & Part B does not cover, like dental and vision.

When you have Original Medicare Part A & Part B, you can see any doctor or healthcare provider anywhere in the United States who accepts Medicare, and that provider will get paid directly by Medicare for their services.

Private fee-for-service plans (PFFS) and Original Medicare Part A & Part B have a few differences. For example:

  • Private fee-for-service plans must have a limit on out-of-pocket costs. The out-of-pocket limit can be high but may help protect you if you’re in need of expensive treatments or regular health care.
  • Out-of-network doctors may not treat you because they do not accept your plan.
  • Private fee-for-service plans are measured geographically. There may be more than one PFFS plan network in your area, and each plan network might have different costs. In Original Medicare Part A & Part B, the benefits and costs are the same nationally.
  • Private fee-for-service plans can decide to stop offering coverage or change benefits packages on a yearly basis.
  • Many people who have Original Medicare Part A & Part B also purchase a Medigap (or Medicare Supplement Insurance Plan) policy to help pay some their costs like deductibles or copays. Medigap policies are supplemental insurance plans that fill in the gaps left behind in Original Medicare Part A & Part B. You cannot have a Medigap and a Medicare PFFS plan together.

If you have additional questions regarding private fee-for-service (PFFS) or other Medicare Advantage plans, give us a call! We can review any of your Medicare health plans and ensure the way you currently receive your Medicare benefits meets your medical and financial needs.

Contact a licensed insurance agent at Medicare Pathways by calling 866-466-9118 today!