Are you considering enrolling in a Medicare Advantage plan (Medicare Part C)? There are several different types of Medicare Advantage plans that may be available in your area. One type of Medicare Advantage plans is a Private-Fee-For-Service (PFFS) plan.
You might consider signing up for a Medicare PFFS plan if you are interested in having some flexibility in your health care choices.
Some of the features of a Medicare PFFS plan that may be attractive to some people who are comparing Medicare Advantage plans include:
In the case of an emergency, you can receive treatment from any health care provider or hospital, regardless of whether they have agreed to the terms of your plan.
A Medicare PFFS plan may offer more flexibility in many cases than a Medicare Health Maintenance Organization (HMO) plan or a Medicare Preferred Provider Organization (PPO) plan.
PFFS plans may or may not include provider networks. PFFS enrollees can generally see any provider they wish as long as that provider has agreed to the terms of the plan, but your out-of-pocket costs will typically be lower if you stay within the plan network, if your plan has one.
Provider payment rates may vary based on their specialty or location. Some out-of-network providers may choose not to cover your care, even if they have treated you before.
It’s important to ask your doctor if they accept the payment terms of your Medicare Advantage plan before seeking treatment, regardless of which type of Medicare Advantage plan you have.
Like all Medicare Advantage plans, PFFS plans offer the same benefits that are covered by Medicare Part A (hospital insurance) and Part B (medical insurance).
Medicare PFFS plans may offer additional benefits not found in Medicare Part A and Part B (also called Original Medicare). These benefits can include (but aren’t limited to):
The list of additional benefits Medicare Advantage plans can offer may grow to include additional services in 2019.
Some of these new additional benefits could potentially include:
The list of additional benefits offered by a Medicare PFFS plan will vary from one plan to the next. Not all plans are available in all areas.
If you want to enroll in a Medicare Advantage PFFS plan, you must first enroll in Medicare Part A and Part B. There must also be a Medicare Advantage PFFS plan available in your area in order for you to enroll.
In most cases, you will not be able to enroll in a PFFS plan if you have End Stage Renal Disease (ESRD). If you have ESRD, you may be eligible for a Medicare Advantage Special Needs Plan (SNP).
If you enroll in a Medicare Advantage PFFS plan, you must continue to pay your Medicare Part A (if required) and Part B premiums while enrolled in the plan. Additionally, the PFFS plan may charge its own premiums, which you are responsible for paying.
There may be $0 premium plans available in your area.1
Some PFFS plans will have annual deductibles, and most PFFS plans will have some sort of cost-sharing measures such as copayments or coinsurance when you receive covered services.
Medicare PFFS plans are not as popular as some other types of Medicare Advantage plans. In 2017, 184,595 people in the United States were enrolled in a Medicare PFFS plan.2 This accounts for around 1% of all Medicare Advantage plan enrollment.
In comparison, almost two thirds of all Medicare Advantage beneficiaries were enrolled in a Medicare HMO plan in 2017, and around one third of enrollees were in a Medicare PPO plan.3
You may want to consider a Medicare PFFS plan if you value flexibility in your health care options.
To learn more and to compare Medicare Advantage plans that may be available in your area, speak with a licensed insurance agent by calling TTY Users: 711 24 hours a day, 7 days a week.
1 You must continue to pay your Medicare Part B premium. $0 premium plans not available in all areas.
2 Kaiser Foundation. Medicare Advantage Total Enrollment, by Plan Type. Retrieved from https://www.kff.org/medicare/state-indicator/total-enrollment-by-plan-type/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
3 Kaiser Foundation. Medicare Advantage 2017 Spotlight: Enrollment Market Update. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update.
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