Medicare Advantage Private Fee For Service Plans
How Do Private Fee-For-Service Plans Work?
Medicare beneficiaries that enroll in PFFS plans can see a specialist without referrals, and they are not required to choose a primary care physician. You can use any healthcare provider who accepts the payment terms and conditions of the plan. Some Private Fee-For-Service Plans have networks of service providers who provide care to anyone signed up for the plan, and this costs less.
Healthcare providers can choose to accept your plan per visit or patient basis. Keep in mind that a hospital that treated you a few months ago may decide not to accept your plan on the next visit, meaning you should also ask your providers if they will accept your PFFS plan before every visit.
What Do Private Fee For Service Plans Cover?
Your PFFS plan covers everything that Original Medicare typically does. This coverage includes:
- Hospital Stays
- Doctor’s Visits
- Preventive Care
- Certain Medical Equipment
- Emergency Room Visits
- Ambulance Rides
Private Fee-For-Service Plans also cover additional services such as vision, hearing, and dental care. Some PFFS plans also provide coverage for prescription drugs. If your plan doesn’t cover medications, you can purchase a separate Medicare Part D plan.
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What Will a Private Fee For Service Plan Cost?
In PFFS, the insurers decide the amount they will pay for a procedure or service and what a member must pay. The PFFS plan costs may include deductibles, copayment, or coinsurance. With Private Fee-For-Service Plans, you still need to pay a Part B premium and Medicare Advantage plan’s premium. A PFFS may also permit “balance billing,” in which a network provider is allowed to charge you an additional 15% over the PFFS plan’s payment rate.
If you have never signed up for a Medicare Advantage plan or have more questions about Medicare Advantage Private Fee-For-Service Plans in general, feel free to contact ReLion Insurance Solutions.
