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Medicare Advantage PFFS Plans

Private Fee-for-Service (PFFS) plans are unique in that what you pay for medical services is determined by your plan. Most plans allow you to go to any Medicare-approved provider that accepts the plan’s payment terms. Other plans have networks of physicians and hospitals that can help you to keep your costs lower. 

The insurance company that you purchase your plan through will decide how much you pay for your medical services and how much of your care they will cover. You may be responsible for covering the coinsurance costs and copays for your visits.

Who can you get treatment from?

With most Medicare Advantage PFFS plans, you can receive treatment from any Medicare-approved doctor or health care provider, as long as they agree to the payment terms of your plan and are willing to treat you. However, it is important to understand that providers may decide to accept your PFFS plan for one visit and choose to deny it on another day

However, some plans have a network of physicians and hospitals. If you choose to visit a provider within the plan’s network, you will be guaranteed treatment. With these plans, you still have the option to visit out-of-network physicians, but you may have to pay more out of pocket.  

Do you get prescription drug coverage?

Some PFFS plans offer drug coverage, but if you end up enrolling in a plan that doesn’t include drug coverage, you still have the option to sign up for a stand-alone Medicare prescription drug plan.

Do you need a referral to see a specialist?

Some people may appreciate the fact that with PFFS, you are not required to get a referral to see a specialist. Additionally, you don’t have to choose a primary care doctor, though doing so could be helpful when it comes to organizing your care. 

It is important to keep in mind that with PFFS plans, your health care provider choices may be limited, as you are required to find a provider who agrees to treat you under the plan’s terms. Additionally, you will be responsible for covering your Part B premium on top of the plan’s premium. 

If you aren’t sure whether a PFFS plan could be a good fit for you, or need guidance in the process of choosing a Medicare insurance policy, reach out to a licensed insurance agent here at Medicare Plans Direct.

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