What Is a Medicare PFFS Plan?

Medicare Advantage plans are private health insurance plans available to seniors who qualify for Medicare. These plans cover Parts A and B of Medicare insurance and typically also include prescription drug coverage and other services such as hearing and dental that Original Medicare does not cover. Medicare Private Fee-for-Service (PFFS) Plans are one of four common kinds of Medicare Advantage plans. The other three common types are:


· Medicare Health Maintenance Organization (HMO) Plans

· Special Needs Plans (SNP)

· Medicare PPO Plans


A Medicare agent at PBC can help you learn about whether a Medicare PFFS plan is right for you. In this article we’re going to take an overall look at Medicare PFFS Plans and how they work.


How Medicare PFFS Plans work


PFFS Plans may or may not have an established network of doctors and hospitals. Plans without a network can be convenient because members can seek care from any Medicare-approved doctor or hospital that accepts both Medicare and your plan’s terms and conditions. Kupuna who choose a PFFS Plan with an established healthcare network can seek medical care from any network providers who have agreed to always treat plan members.


Though PFFS Plans have a requirement like other Medicare Advantage plans to provide seniors with the same benefits, rights, and protections as Original Medicare, the plan is allowed to determine how much it will pay medical providers and hospitals