Private-Fee-For-Service (PFFS) Plans
Private Fee-for-Service (PFFS) plans are a type of Medicare Part C or Medicare Advantage plan. The other types of Medicare Advantage plans are PPO (Preferred Provider Organization) plans, Health Maintenance Organization (HMO) plans, and Special Needs Plans (SNPs). HMO and PPO plans are the most popular options. However, PFFS plans may be a better fit for your personal needs.
All Medicare Advantage plans, including Private Fee-for-Service plans, offer a bundled alternative to Medicare Part A and Medicare Part B (known as Original Medicare). Private Medicare-approved companies offer these plans, and they always provide full Original Medicare coverage. Depending on your plan, it may also include extra coverage like dental, vision, prescription drug coverage (Medicare Part D), and/or wellness and fitness programs like gym memberships.
Private Fee-for-Service plans offer more flexibility than HMO or PPO plans, allowing you to see any Medicare-participating doctor who is willing to accept the terms of your plan.
Who Can Get A Private Fee-for-Service Plan?
Anyone who has Original Medicare and lives in an area where these plans are provided can opt for a Private Fee-for-Service plan.
What Do Private Fee-for-Service Plans Cover?
Private Fee-for-Service plans always provide at least the same level of coverage as Original Medicare (Medicare Part A and Medicare Part B). Depending on your plan, a PFFS plan could also include prescription drug coverage.
Is A Private Fee-for-Service Plan A Good Fit For You?
A Private Fee-for-Service plan could be a great option for you if you need a lot of freedom and flexibility in your health care coverage. However, it typically costs more than an HMO or PPO plan.
There are some important things to know before you choose a PFFS plan. When you have a PFFS plan:
- A referral is not needed to see a specialist.
- Choosing a primary care provider is also not required.
- There is no guarantee that your plan’s payment terms will be accepted by a medical provider. However, non-network providers are allowed to choose to accept PFFS plan patients on a patient-by-patient basis.
- Many PFFS plans do have provider networks (although some plans may not have one). If your plan does have a network, you can typically still go out-of-network as long as the medical provider accepts your plan’s payment terms, but you will probably pay more by doing so.
Retirement Should Be Fun, Not Confusing
Simple Retirement Benefits can help you get rid of the confusion and get back to the fun. Choosing a Medicare plan can be difficult, but it doesn’t have to be! At Simple Retirement Benefits, we work day-in and day-out to help you find a Medicare plan that suits your needs and budget. Call us today at 512-432-5414 to receive your free quote.
Reach out to
Simple Retirement Benefits, LLC
If you are still unsure of which Medicare plan is right for you, we can help. We will discuss all the coverage options with you to determine which plan is best for your needs.
Give us a call today to speak with one of our agents.
