How a Medicare Advantage Private Fee-for-Service Plan Works
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 usually still go out-of-network if the providers approve your plan’s payment terms and conditions. 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, plus a separate premium for your PFFS plan — if there is one.
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
Since 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
- And more
The benefits you are eligible for depend 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.