Medicare Supplement Medicare Advantage plans that are provided by private insurance companies are known as PFFS (Private Fee-for-Service) plans. PFFS plans function in a distinct manner from other Medicare Advantage plan types and regular Medicare. An outline of Medicare Advantage PFFS plans is provided below:

Flexibility in Provider Choice

Any healthcare provider that agrees to the terms and conditions of the plan’s payment can be used with PFFS plans. This implies that you can visit any physician, specialist, or hospital that accepts the terms of the plan for payment and agrees to treat you. It is important to confirm with each provider before seeking care, though, as not all accept PFFS plans.

No Network Requirement

There is no required provider network for PFFS plans. If you would rather not be restricted to seeing any Medicare-approved provider who agrees to the rules of the plan—regardless of whether or not they participate in the network—this may be helpful.

Payment Terms

Healthcare providers that accept these terms can treat you; PFFS plans determine the amount they will pay for treatments. Providers may choose to accept or reject the plan’s payment terms on an individual basis. The plan establishes the payment rates. Prior to receiving care, make sure your healthcare providers accept your particular PFFS plan to avoid any surprises in expenses.

Additional Benefits

PFFS programs, like other Medicare Advantage plans, could provide extra benefits on top of Original Medicare. Prescription medication coverage, dental, vision, and hearing care, as well as wellness initiatives and other services, may be included in these benefits.

Referrals and Prior Authorization

A primary care physician’s (PCP) referral is typically not needed in order to see a specialist under PFFS plans. But before receiving care, some services could need the plan’s prior authorization.

Monthly Premium

There is typically a monthly fee for PFFS policies. You will be required to pay both this premium and your Part B monthly payment in addition to this one.

Looking for the Right Plan? We Have You Covered 

We at Insurance Corner Medicare Group will go over all of your options for coverage and make sure the plan you select meets your medical needs.

Give us a call right now to find out more about our services and whether a PFFS plan is right for you.