Medicare PFFS

Medicare PFFS stands for Private-Fee-for Service and is a certain kind of Medicare Advantage plan available in select areas.

What is a Medicare PFFS plan?
medicare pffs plan
PFFS plan members must present their insurance ID card at the time of service

A PFFS plan is a type of Medicare Advantage plan. It is not a Medicare supplement – it works differently.

If you join a Medicare PFFS plan, you agree to pay the plan’s premiums as well as co-pays and coinsurance for medical services as outlined in the plan. The thing that makes these plans different from an HMO or PPO is that you are not limited to any certain network of providers.

Instead, you are to present your Medicare PFFS plan ID card to any provider before seeking medical care. Before treating you, the provider must agree to accept the plan’s payment terms and conditions and bill the plan.

Two common features about Medicare PFFS plans are:

You can present your card to any Medicare-participating provider in the U.S. and ask if that the provider will treat you. For this reason, Medicare PFFS plans popular among Medicare recipients who travel frequently.
Some Medicare PFFS plans allow you to have a separate Part D drug plan. You can choose a PFFS plan with a built-in drug plan or a PFFS plan for “medical only” and enroll in a separate drug plan
In the past, some people have confused PFFS plans with supplements. It is important you understand the following:

A Private Fee-for-service plan is NOT Medicare supplement insurance. Providers who do not contract with the plan are not required to treat you except in an emergency. This puts the responsibility on your shoulders to discuss with any healthcare providers whether or not they agree to see you and bill the plan.

Learn more about Medicare PFFS plans
Because of the rules about how to access providers, it is particularly important to work with a good insurance agent when researching your options. You need to fully understand how, where, and when you can use your coverage so that there are no surprises when you are seeking medical care.

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