Medicare Advantage Private Fee-for-Service (PFFS) Plans offer a unique structure compared to other Medicare Advantage plans, providing flexibility with some important limitations.
Key Features
Contracted Provider Network:
- PFFS plans often have a network of doctors, healthcare providers, facilities, and suppliers that agree to treat PFFS plan members.
- You can access a list of these network providers for ease of care.
Out-of-Network Services:
- If you receive care from a provider outside the network for non-emergency or non-urgent services, your plan may not cover those costs, or your expenses may be significantly higher.
Prescription Drug Coverage:
- Some PFFS plans include Part D prescription drug coverage, but not all do. Be sure to check whether your chosen plan includes drug coverage.
Flexibility
- No Primary Care Doctor Required: You are not required to designate a primary care physician.
- No Referral Needed: You don’t need a referral to see specialists, providing greater freedom to manage your healthcare.
Costs
- Costs Vary by Provider: Your costs depend on whether the provider accepts the terms and payment rates of your PFFS plan.
- Potentially Higher Costs for Out-of-Network Care: Using providers outside the network may result in higher costs or no coverage for certain services.
Advantages
- It offers greater flexibility in choosing healthcare providers than some other plans.
- Simplifies access to specialists without requiring a referral.
- It may include prescription drug coverage, combining multiple benefits into one plan.
- Considerations
- Confirm that your preferred doctors or facilities accept the plan before receiving care.
- Be aware that care outside the network can be more expensive or not covered.
PFFS plans are ideal for individuals who want flexibility in their healthcare choices and don’t want to deal with referrals, but they require careful attention to provider acceptance and potential costs for out-of-network care.
