Medicare Advantage

Private Fee-for-Service Plans

Medicare Advantage Plans are optional Medicare plans offered by Medicare-approved private companies and available to people already enrolled in Original Medicare (Medicare Part A and Part B).

Medicare Advantage plans can provide additional coverage in various areas of health including dental, vision, and hearing, and most plans also include prescription drug coverage.  Among the most popular Medicare Advantage Plans are Medicare Private Fee-for-Service (or PFFS) Plans.

Under the various PFFS Plans available throughout the country, Medicare provides monthly payments to private insurers, which in turn determine how much to charge policyholders for various medical services.

While some Private Fee-for-Service Plans offer full or partial networks of providers, all PFFS Plans give you great flexibility by allowing you to receive services from any health care provider agreeing to the terms and conditions of your PFFS Plan. It’s important, though, to make sure your doctor or hospital agrees to your plan’s payment terms before you consider accepting any medical services. If your health care provider doesn’t agree, you’ll need to find another one that does. You should play it safe by confirming your provider’s agreement to your plan’s terms and conditions every time you arrange a visit.

Joining a Medicare Private Fee-for-Service Plan does not affect your eligibility for all medically-necessary services covered by Medicare Part A and Part B. You need to be aware, however, that a PFFS Plan may not cover the cost of a procedure not deemed medically-necessary under Medicare.

You can request an advance coverage decision from your insurer, and you have the right to appeal your insurer’s decision concerning what medical services are or aren’t necessary. But it’s important to choose a plan and insurer you can trust.

Availability of PFFS Plans varies in different parts of the country, and even within individual regions and states. Premiums, deductibles, coinsurance, and copayment amounts can vary widely as well, along with coverage considerations that need to be crystal clear to any policyholder. With so much to consider, it’s vital to have an expert like MedicareMall in your corner to ensure you’re getting the best coverage available at the lowest possible cost.

If you have any questions about Medicare Private Fee-for-Service Plans, contact MedicareMall now and let us put our two decades-plus of experience to work for you!

Medicare Advantage Plans Index