Medicare Advantage PFFS Plan

What Is a Medicare Advantage PFFS Plan

If you have ever looked into Medicare Advantage Plan coverage options, you probably come across Private Fee For Service (PFFS) Plans. Medicare PFFS plans are not very well-known as other standard plans like Health Maintenance Organization (HMO) Plans or Preferred Provider Organization (PPO) Plans.

What is the Medicare Private Fee for Service (PFFS) Plan?

The PFFS Plan is a type of plan offered by a private company in a legal contract with Medicare to provide coverage. The coverage includes payment for doctor appointments, hospital stays, and other medical needs in place of Medicare Parts A and B.

The amount PFFS will cover for each service is determined by the plan itself, as well as how much you pay for services. The availability of the plan also depends upon your residence.

What does Medicare PFFS Plan cover?

A PFFS Plan will cover everything that any other Medicare Advantage Plan is required to cover. To give you a clear picture, this includes:

  • Adult day-care services
  • Fitness memberships
  • Nutrition programs
  • Prescription drugs
  • Over-the-counter drugs
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits
  • Wellness programs

Considering that PFFS is a Medicare Advantage Plan, it may cover additional dental, vision, or hearing care services.

What are the pros of Medicare PFFS Plans?

The choice to accept payment from the PFFS plan rests with healthcare providers for each service you receive. To put it simply, this could mean that your doctor might only accept the PFFS plan for one service and not for another. This means that you must check every time to know whether your plan applies to the kind of service you wish to receive.

It is not a requirement to choose a primary care physician. Having referrals is also not necessary to consult a specialist.

If you would like more information regarding your eligibility for PFFS Medicare Advantage Plans, feel free to reach out to one of our representatives.

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