Do you know what the PFFS Advantage Plan is?

 

A fee-for-service Medicare Advantage plan, also known as PFFS (Private Fee-for-Service) plan, is a specific type of Medicare Advantage plan with some unique characteristics. Here's a breakdown:

Basics:

• Combines Part A and Part B: Like all Medicare Advantage plans, it replaces Original Medicare (Parts A & B) and offers combined coverage.
• Fee-for-service model: Unlike most Medicare Advantage plans with networks, you can visit any doctor or hospital accepting Medicare, similar to Original Medicare.
• Plan determines payment: The plan negotiates rates directly with providers, not set networks, and pays them based on individual services instead of capitation (fixed payments).

Key Features:

• More flexibility: You're not limited to a specific network of providers, giving you more freedom in choosing your care.
• Potentially lower out-of-pocket costs: If you stay within the plan's negotiated rates, you might pay less compared to network-based plans.
• Less predictable costs: Since rates aren't fixed, unexpected bills are possible if providers charge more than the plan negotiates.
• Limited drug coverage options: Not all PFFS plans include Part D (prescription drugs). You might need a separate plan for drug coverage.

Who might consider a PFFS plan:

• Individuals who value flexibility and prefer seeing any Medicare provider.
• Those comfortable navigating different billing practices and potential out-of-pocket costs.
• People who anticipate using out-of-network providers frequently.

Important notes:

• Availability of PFFS plans varies by location. Check with Medicare for options in your area.
• Carefully review the plan's details, including provider payment terms and potential out-of-pocket costs.
• Compare PFFS plans with traditional Medicare Advantage plans to see which best suits your needs and budget.
• To find out if you qualify and explore available plans in your state, visit medicare.gov or contact your local Medicaid office. You may also Click Here and a licensed skilled agent will be in contact to answer any questions you may have.