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Medicare Private Fee-for-Service (PFFS) Plans

Learning Center > Medicare Advantage Resources > Medicare Private Fee-for-Service (PFFS) Plans

What is a Medicare Advantage PFFS Plan?

A Private-Free-for-Service plan is just a Medicare Advantage Plan (Part C) that is offered by a private insurance company. When you’re enrolled in a Medicare Advantage plan of any kind, even a PFFS plan, you still are enrolled in the Medicare program. PFFS plans must include both Part A and Part B. If you enroll in a PFFS plan, you can usually visit any doctor or hospital that is Medicare-approved and accepts the plan’s payment terms and is willing to treat you. The plan decides how much you will pay for doctors, hospitals and other treatment, not Medicare. PFFS Medicare Advantage plans usually have benefits that Part A and Part B don’t have, like prescription drug coverage.

Benefits of Medicare Advantage PFFS Plan:

  1. Plans may cover hearing, vision and/or dental
  2. Plans often include prescription drug coverage
  3. Offer fitness programs
  4. Original Medicare can’t be used outside the U.S., but some PFFS plans offer coverage when you travel outside the U.S.
  5. You don’t have to choose a primary care doctor and don’t need a referral from a primary care physician to see a specialist
  6. Many PFFS plans don’t have network restrictions. Many offer you to go to any Medicare-approved doctor, healthcare provider or hospital, provided they accept the plan’s payment terms and agrees to treat you.
  7. You could have fewer out-of-pocket expenses because enrollees are typically capped at $6,700. Once you reach your out-of-pocket max, your Medicare Advantage insurance plan will pay 100% of additional covered charges for the rest of the year. Original Medicare doesn’t have an out-of-pocket annual maximum so you could end up spending more.
  8. You will have at least the same coverage as Original Medicare and they can’t charge more for things such as chemotherapy, dialysis, and nursing facility care.
  9. A single card will take care of your medical, hospital, and prescription drug benefits. With Original Medicare you will have three cards, one for benefits, one for supplemental insurance, and another for prescription drug (Part D) program.
  10. Medicare Advantage plans are seen as a pay-as-you-go plans. Which means you pay a co-payment when you see a doctor or specialist, have a diagnostic test, or a hospital stay. Some Medicare Advantage plans have little or no premium so could potentially save you money.
  11. Medicare Advantage plans usually have a lower monthly premium than Medigap plans. Medigap is private health insurance that helps pay for health care costs such as co-payments, coinsurance, deductibles, and coverage not covered by Original Medicare.
  12. Doctors within the plan’s network can be easily available to you. If your doctors are in your network a Medicare Advantage plan may be right for you.

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