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Private Fee For Service

Private Fee For Service

Private Fee-for-Service (PFFS) plans are a type of Medicare Advantage, or Medicare Part C, plan. Medicare Advantage is a bundled alternative to Original Medicare offered by private Medicare-approved companies. Depending on your medical care needs, Medicare Advantage may offer you more coverage and potentially save you money. 

All Medicare Advantage plans provide full Original Medicare coverage (Parts A and Part B). Some plans may include extra coverage such as vision, dental, and/or wellness and fitness programs like gym memberships. These plans offer a bundled alternative to Original Medicare and usually include Medicare Part D (prescription drug coverage). 

The different types of Medicare Advantage plans are Health Maintenance Organization (HMO) plans, PPO (Preferred Provider Organization) plans, PFFS (Private Fee-for-Service) plans, and Special Needs Plans (SNPs).  

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What Are Private Fee-for-Service Plans?

Private Fee-for-Service plans are one of the less popular Medicare Advantage plans. Like all Medicare Advantage plans, these plans are offered by private insurance companies.

With a PFFS plan, you can see any Medicare-participating doctor in the country who is willing to accept your plan’s terms. This makes PFFS plans popular among Medicare recipients who travel frequently or who live in different areas throughout the year.

Who is Eligible for Private Fee-for-Service Plans?

If you are an Original Medicare recipient, you are eligible for a PFFS plan.

What Do Private Fee-for-Service Plans Cover?

Like all Medicare Advantage plans, PFFS plans provide at least the same level of coverage as Original Medicare. Some PFFS plans have a built-in prescription drug plan, and some allow you to enroll in a separate drug plan (like Medicare Part D).

Why Choose a Private Fee-for-Service Plan?

If you need maximum freedom and flexibility, a Private Fee-for-Service plan is a great option. It costs more than HMO or PPO plans, so if you don’t travel frequently or live in different places in different seasons it’s not worth the higher cost.

With a PFFS plan:

  • You don’t have to choose a primary care provider
  • You don’t need a referral to see a specialist
  • There is no guarantee a medical provider will accept your plan’s payment terms or provide treatment for you, unless your doctor has an agreement with a PFFS network or you require emergency treatment. Non-network providers get to choose to accept PFFS plan patients on a patient-by-patient basis. 
  • There is typically no provider network, but for some plans there could be. If your plan does have a network, you can usually still go out-of-network as long as the provider accepts your plan’s payment terms.

How Do PFFS Plans Compare to Other Medicare Advantage Plans?

HMO plans and PPO plans both rely on networks of providers, HMO plans even more so than PPO plans.

HMO plans, PPO plans, and PFFS plans all:

  • Offer full Original Medicare coverage
  • Are offered through private Medicare-approved insurance companies

However, there are key differences. HMO plans and PPO plans:

  • Always use provider network
  • Require you to live within the plan’s service area

PFFS plans do not. Unlike HMO plans and similar to PPO plans, PFFS plans also do not require referrals for specialized care or primary care doctors.

Overall, PFFS plans offer the most freedom, but it comes at a cost.

Need Help Deciding What Plan Is Right For You?

Speak with Senior Health Solutions in Opelika, AL today. We offer the specialized expertise you need to decide what plan is best for you and your health care needs. Just give us a call at (866) 445-5215 today to go over your options.

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(866) 445-5215

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We are not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.