Medicare Advantage Private Fee-For-Service Plans

A Medicare Private Fee-for-Service Plan is part of the Medicare Advantage Plans or Medicare Part C. Offered by private insurance companies, this plan works a little differently than the other plans. The Private Fee-for-Service Plan has set amounts it pays doctors and hospitals and set rates you must pay for each medical service. 

What Doctors can you See?

Like most Medicare Advantage Plans, the PFFS Plan has a network of doctors. Like PPO plans, if you stay within the network, you’ll pay lower fees for medical services, as the plan negotiates lower rates with in-network doctors. You may see doctors out of the network, but you’ll pay higher fees. 

The key is you must see providers that agree to the fees. If a provider doesn’t agree, you can’t see them, or they may not agree to treat you.

What about Prescriptions?

Like many other Medicare Advantage plans, the PFFS plan may cover prescriptions as a part of the insurance. If they don’t, you are eligible for Medicare Part D, unlike most other Medicare Advantage plans which don’t allow you to have Part D coverage.

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What Else Should you Know About PFFS Plans?

You are free to choose your own doctor in the PFFS plan, and you don’t need referrals to a specialist. Your PFFS plan will determine which doctors you can see.

  • Some plans have a network of doctors that will see anyone in the plan
  • Out of network doctors don’t have to see you even if you are a previous patient
  • Always make sure the doctor or hospital accepts the fees from the plan before getting any services
  • The only exception to the rule is an emergency – all doctors and hospitals must treat you
  • Your only out-of-pocket expense is the amount outlined by the plan as long as the doctor/hospital accepts it before the service

Call Senior Insurance Representatives to Learn More

Are you wondering if a Medicare Part C plan or Private-Fee-For-Service plan is right for you? We know it can be confusing trying to figure out which plan is right. Let the experts at Senior Insurance Representatives help. We have many years of experience dealing with Medicare Part C plans and can help you choose the perfect option. Call us at 1-800-327-7888.