4 Key Takeaways of Medicare Advantage Private Fee-for-Service (PFFS) Plans

Medicare Advantage is a great way to get all the same benefits as Original Medicare, plus a few extras like Part D prescription drug coverage. Most people who have shopped for Medicare Advantage plans already know about Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). However, fewer people are aware of Private Fee-for-Service (PFFS) plans. Let’s take a closer look at the 4 key takeaways of Private Fee-for-Service (PFFS) plans.

Prices for Care Are Not Fixed

One of the key differences between PFFS and other Medicare plans is that the plan provider sets all of the prices, not Medicare. This means that your plan will determine how much they pay to doctors or healthcare facilities. They will also determine how much you pay for every kind of service or treatment you receive.

You Have Network Flexibility

With an HMO plan, you’re mostly limited to care within your network. Alternatively, PPO and PFFS plans give you a lot more flexibility to seek care from just about any doctor or clinic. While some PFFS plans don’t use networks, others do. Even if you acquire a plan that uses networks, you can receive care inside or outside of your network and still get coverage. That said, you should generally expect higher prices when seeking care outside of your PFFS network.

You Need to Make Sure Your Doctor Accepts Your Plan

Doctors and clinics have the right to refuse care based on your insurance plan. Since PFFS plans set the prices they will pay for every type of care, some doctors may not want to treat you based on the specifics of your plan. So, before you seek treatment, make sure that your doctor will work with your PFFS plan. Generally, PFFS plans contract with network providers to ensure that there are some doctors and facilities in your network that will always accept your plan.

You Don’t Need to Choose a Primary Care Provider

Since some doctors can refuse care based on the specifics of your PFFS plan, you are not required to choose a primary care physician. Additionally, you do not have to get a referral to seek out the care of a specialist. This way, you have more freedom to choose exactly how and when you get care.

The Bottom Line

A Medicare Advantage Private Fee-for-Service (PFFS) plan is one of the more unique options available to older adults. Every time you go to a doctor or hospital, you may pay different amounts based on the type of care you receive. Additionally, you’ll need to ensure that your doctor accepts the terms and conditions of your plan before you receive care. In any case, PFFS is a solid option for older adults who want a Medicare Advantage plan with more flexibility.

If you’d like to learn more about Medicare Advantage PFFS plans or your Medicare coverage options, feel free to fill out this form or give us a call anytime. Time for 65’s partnered licensed agents are focused on giving you the information you need, with zero pressure to enroll in a plan.