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Private Fee for Service

Medicare Private-Fee-for-Service (PFFS) is a certain type of Medicare Advantage plan available in special areas. 

What Exactly Is a Medicare PFFS Plan?

A PFFS plan works differently than a Medicare supplement. By joining a Medicare PFFS plan, you consent to pay the plan’s premiums, plus copays and coinsurance for medical services as defined in the plan. 

What separates these plans from an HMO or PPO is that you’re not restricted to any particular network of providers. Instead, you present your insurance plan ID card to any provider at the time of service. Before they treat you, the provider has to agree to approve the plan’s payment terms and conditions and render the plan.

Common Features About Medicare PFFS Plans

  1. You can show your card to any Medicare-participating provider in the country and ask if they’ll treat you. This makes PFFS the preferred plan among Medicare recipients who travel often. 
  2. Some Medicare PFFS plans let you have a separate Part D drug plan. You can select a PFFS plan with a build-in drug plan or a PFFS plan for medical only and enroll in an independent drug plan. 

Don’t Confuse PFFS Plans with Supplements

It’s crucial to understand that a PFFS plan is NOT Medicare supplement insurance. Healthcare providers who don’t contract with the plan aren’t obligated to treat you — unless it’s an emergency. So, it’s your responsibility to discuss with any providers whether or not they consent to see you and render the plan.

TitleLearn More About Medicare PFFS Plans

Since there are rules about how to reach providers, it’s important to work with a trusted insurance agent when you explore your options. We’ll help you understand how, when, and where you can use your coverage so that there are no curveballs when you’re pursuing medical care.  

Cornerstone Senior Advisors has insurance agents with vast knowledge about PFFS plans. Ask us about PFFS plans in your area. You can call us in Wichita at (316) 260-3331!