How Does PFFS Work?
When you purchase a PFFS plan, you do not have to select a primary care physician and you do not need a referral to see a specialist. Here is how it works:
- You must be enrolled in Original Medicare to have this plan.
- There may be a healthcare provider network, so talk to a licensed Medicare agent to make sure.
- you can visit out-of-network doctors if they accept your provider’s payment as payment in full, but first, check with the healthcare provider.
- The same goes for any healthcare provider. Non-network providers may choose to accept a PFFS plan on a case-by-case basis.
- Also, you will continue to pay your Part B premium, and maybe your plan’s premium too, if the provider requires so
What separates PFFS plans from the rest is that the insurance company decides 1) how much it will pay your healthcare provider, and 2) how much you pay for a covered health service. With other plans, Medicare dictates these rates.
What a Private Fee-for-Service Plan Covers
ince a PFFS plan is a type of Medicare Advantage plan, if offers extra benefits that Original Medicare does not, which can include:
- Nutrition programs
- Fitness memberships
- Over-the-counter drugs
- Adult day-care services
- Dental, Hearing, and Vision
- Transportation to doctor visits
The benefits you are eligible for depending on your area and plan providers. Usually, a PFFS plan includes a Part D plan. If not, however, you will need to join an independent Part D plan to get prescription drug coverage.