Medicare Advantage PFFS Plans
Private fee-for-service (PFFS) plans generally operate without a provider network, allowing you to receive service from any health care provider who agrees to treat you and accepts your plan's payment terms. These plans are especially useful for people with a small variety of health care providers or who plan to spend a lot of time beyond the limits of other plan networks (for example, splitting time living in two households). With a PFFS, you can expect to pay premiums, deductibles, copayments and coinsurance.
For more information about the benefits of joining a PFFS plan in your area, contact a PFFS agent. Avila Medicare Solutions today.
Introduction to PFFS
Private fee-for-service (PFFS) plans are one of the most unique types of Medicare Advantage plans available. They offer flexibility to see any health care provider who agrees to treat you and agrees to the plan's payment terms.
These plans have historically been more popular in rural areas, where network plans were more restrictive and health care providers are few and far between. A PFFS plan may be a good option for you if you maintain multiple residences or travel frequently across the country. The lack of network restrictions makes this plan a popular choice for people who live in freedom.
PFFS Coverage
PFFS plans are a type of Medicare Advantage plan, so they give you the same coverage as Original Medicare with Medicare Part A and Part B. This means you have coverage for inpatient hospital care in a hospital or skilled nursing facility, hospice care, home health care, preventive care, and medically necessary care. This means you have medical and hospital coverage for inpatient care in a hospital or skilled nursing facility, hospice care, home health care, preventive care, and medically necessary care.
Your plan may also offer additional coverage for things that are not included in Part A and Part B, such as prescription drug coverage, dental care, vision care, hearing care and more. Choosing to purchase these plans will result in additional monthly premiums.
PFFS Costs
For your PFFS plan, you will pay premiums, an annual deductible, copayments and coinsurance. These costs will vary between plans and will be based on accepted fair costs for covered services. You must also continue to pay your monthly Medicare Part A and Part B premiums while in a PFFS plan.
If your plan has a network, you will pay lower costs to receive services from health care providers within your plan's network. Seeing specialists or visiting the emergency room will result in higher out-of-pocket costs.
Plan comparison
Unlike HMOs and PPOs, PFFS plans generally do not have networks of health care providers. You can receive care from any health care provider who agrees to treat you and accepts your plan's payment terms.
You do not need a primary care physician and do not need referrals to see a specialist. If your plan has a network and your current primary care physician is not in-network, you can continue to see him or her.
To find out if a PFFS plan is a good health insurance option for you, or to learn more about Medicare Advantage plans available in your area, call us toll-free at 855-GO-AVILA or click the button below to request information.
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