What is Private Fee-for-Service Care?

Private fee-for-service plans are a type of Medicare advantage care. They offer the same coverage as the Original Medicare program, but with different rules and stipulations. PFFS coverage plans are offered by private companies. The type of plan determines how much doctors, hospitals and other healthcare providers are paid. The plan also sets how much you pay upon receipt of care.

If you’ve never enrolled in a Medicare Advantage plan, or if you just have questions about PFFS plans in general, keep reading to learn more about what this coverage option means. Feel free to contact us if you have any questions about coverage.

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What do I need to know about PFFS coverage?

PFFS coverage care is given by doctors who decide to accept the terms of the plan

What are the Costs for PFFS Care?

PFFS plans are customizable, and the costs a different for each. Typically, a monthly premium is charged on top of Medicare Part B coverage. Costs may be higher for subscribers with Medicare Part D coverage.

To mitigate high out-of-pocket expenses, PFFS plans are given an annual limit. For 2019, the maximum limit was set at $6,700. Some plans may set a lower limit. Ask your healthcare agent for more information.

Who Can I See With PFFS Coverage?

Like PPO plans, you do not have to choose a primary care provider (PCP). Also, you do not have to have referrals to see a specialist. Plans include different options depending on your needs. Usually, plans include the option for you to see any Medicare participating doctor or another provider that accepts the terms and conditions of the plan. Some plans give you access to a network of providers that agree to accept and treat anyone on the PFFS plan. You can see providers out of the network, but costs will be lower if you stay in-network.

PFFS coverage is usually given within a network of healthcare providers
Female patient showing medical provider her PFFS coverage card

What Do I Need to Know When I Receive Care?

Bring your insurance plan card with you, every time you receive care. Sometimes, and with some plans, providers may decide not to treat you, even if you’ve seen them in the past. Providers can choose at any time to not accept the terms and conditions of your PFFS plan. Original Medicare will not pay for care while you have coverage through a Medicare PFFS plan. Be prepared to pay any copays or coinsurance costs described in your plan.

Will My PFFS Cover My Prescriptions?

It depends on the PFFS plan. If you need prescription drug coverage, look for PFFS plans that will cover them. If you have a PFFS already that doesn’t cover your prescriptions, you can get coverage with a Medicare Prescription Drug Plan.

Let Us Help You Find The Right Plan

At Buffalo Health Advisors, we believe in providing solutions to individuals as they transition to Medicare plans. Not only can Medicare Advantage work to protect your health, choosing the right plan can go a long way toward protecting your wealth. This plan is critical if you are going to be living on a fixed income during your retirement years.

It will cost you nothing to learn more about the options available to you. Call or stop by our Nashville, TN office to discuss your Medicare plan options with one of our experienced health insurance agents.

To learn more about how working with a health insurance agent can help you, visit our In the Media page for helpful videos about getting started with health insurance.

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Click below to receive a free quote for either individual health plans or Medicare Advantage plans.

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