Private Fee for Service

PFFS Medicare Private Fee-for-Service

A Medicare Private Fee-for-Service (PFFS) plan is a type of Medicare Advantage plan offered by private insurance companies. PFFS plans are designed to provide Medicare beneficiaries with an alternative way to receive their Medicare benefits, combining both hospital and medical coverage.

Just like other Medicare Advantage Pans, you must be enrolled in both Medicare Part A and Part B.

PFFS plans offer flexibility in choosing healthcare providers. Unlike traditional Medicare, which typically requires you to see healthcare providers who accept Medicare assignment, PFFS plans allow you to see any doctor or healthcare provider who agrees to the plan’s terms and conditions. However, it’s important to note that not all providers may accept the plan, so it’s important to check with your providers beforehand.  Also keep in mind that providers are allowed to change their minds.  A provider may see you one week and decide not to see you afterwards.

PFFS plans generally provide the same coverage as Original Medicare including hospital stays, doctor visits, preventive services, and medically necessary services. Some PFFS plans may also include prescription drug coverage (Part D). It’s essential to review the plan’s coverage details to understand what services and medications are included.

Unlike other Medicare Advantage Plans, you can have a PFFS plan and a Medicare Prescription Drug Plan (PDP) at the same time. PFFS plans typically provide coverage for both medical services (Part A and Part B) and may also offer prescription drug coverage (Part D) as part of their plan. However, not all PFFS plans include prescription drug coverage.

PFFS plans typically have cost-sharing requirements such as deductibles, copayments, and coinsurance.

PFFS plans generally cover both in-network and out-of-network care. However, the plan’s payment terms and rates may differ for out-of-network providers, and providers can choose whether or not to accept the plan’s terms. It’s important to understand the plan’s rules regarding out-of-network care and associated costs.

It’s important to carefully review the details of any Medicare PFFS plan you are considering, including the plan’s network of providers, coverage, costs, and any additional benefits. You can compare different PFFS plans available in your area using the Medicare Plan Finder tool or by contacting Medicare directly.

I hope that this helps.  I have not yet run into anyone who needed a PFFS plan.  If you are interested and there is a plan available to you in your zip code, we can certainly discuss it.  Feel free to call me at (888) 883-6074 or email me at

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