Medicare Advantage (Part C) PFFS plans are a recent addition. These plans are different than Health Maintenance Organization (HMO), Preferred Provider (PPO) or Medicare supplement insurance (Medigap) plans.
How are these plans different from Original Medicare (Part A and Part B)?
One major difference between PFFS plans and Original Medicare is that enrollees join a plan run by a private insurance company. Plan enrollees typically visit any Medicare-eligible provider, such as a doctor, hospital or other health care service provider, who is willing to accept the plan's payment terms and conditions. It is important to confirm that the provider accepts payment from a specific plan each time services are provided. Doctors or hospitals are not required to agree to accept the plan's terms and conditions, and thus may choose not to treat you. Some providers do not accept PFFS plans or accept only certain PFFS plans. You can receive services throughout the United States.
Some of these plans do not offer prescription drug coverage. If your plan doesn't offer prescription drug coverage, you can buy a standalone Medicare Part D prescription drug plan in addition to a Private Fee-For-Service plan.
Many of these plans do offer a broader choice of covered services than Original Medicare provides. Some cover additional services, like nurse help lines or gym memberships.
Choosing a Medicare Advantage PFFS plan
Medicare Medicare Advantage PFFS plans have much of the same flexibility in setting
premiums,
cost sharing and other terms as Medicare Advantage
coordinated care plans. Just as coordinated care plans vary considerably, the details of PFFS plans can as well.
Pay careful attention to the details of the plan. You may find a wide variation in your estimated out-of-pocket costs from plan to plan, or when you compare your PFFS plan with Original Medicare.
Choosing a Medicare provider
You should confirm that a doctor, hospital or other care provider is Medicare-eligible before receiving services. When choosing a provider, you should also look for one who accepts the terms, conditions and payment rates from the plan before providing service to you. If you don't, you may be responsible for any difference between the plan's payment amount and the provider's total charges. In some cases, you could be responsible for paying all of the charges.
The flexibility of a PFFS plan also means that important features of a plan, like premiums and deductibles, can change from year to year. You'll need to monitor changes in the plan to make sure that it's still the best choice for you.
PFFS plans allow you to use any provider who is willing to accept terms, conditions and payment rates from the plan.