A Medicare Private Fee-For-Service (PFFS) plan is a Medicare Advantage plan, an alternative to Original Medicare (Parts A and B). These plans are individual insurance policies sold by private insurance companies.

Who Treats Me in a PFFS Plan?

Depending on how the plan is organized, you may be able to see any doctor, and use any hospital, or you may be limited to a group of doctors and hospitals that have contracted with the plan. If choice is important to you, it is very important to be clear about this before enrolling.
Again, depending on how the plan is organized, you may be able to see any doctor by paying more out-of-pocket. If you see a doctor who does not accept the plan’s terms, you may have to pay the full cost yourself.

What About Emergencies?

In an emergency, you can use any doctor or hospital, and the plan will pay. Most plans have some doctors who will agree to treat you even if they have never seen you before. Providers outside the panel may refuse to treat you, even if they have seen you before.
What Else Do I Need to Know?

Medicare Advantage PFFS plans cannot require prior authorization for services. Other than that, they run exactly like other Medicare Advantage Plans. They use Federal money over and above the average cost of treating a Medicare beneficiary to offer added benefits such as dental, vision, and hearing, premium reductions or waivers, and prescription drugs. The exact benefits offered depend on each plan, so it is very important to review the plan documents to ensure that all your needs are met.
If you join a PFFS plan that does not provide coverage for prescription drugs, you can enroll in a standalone Medicare Part D prescription drug plan.
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We use easy-to-understand language to help clients better comprehend their choices. Additionally, we will help guide you through an easy process of selecting a Medicare Advantage plan that makes sense for you.

Heritage First offers insurance products and services. We are not affiliated with Medicare or any other government agency. Insurance products are guaranteed by the financial strength and claims-paying ability of the issuing company.