Private Fee-for-Service (PFFS) Plans under Medicare Advantage offer flexibility in choosing healthcare providers, but navigating the terms and conditions can be challenging. With these plans, Medicare pays private insurers, who then set their own rules for costs and services. It’s crucial to ensure your doctor or hospital agrees to your plan’s terms before receiving care, as out-of-pocket costs can add up quickly. Our experienced team at MedicareMall is here to guide you through the complexities of PFFS Plans, helping you secure the best coverage at the most affordable rate—keep reading to learn more about how a PFFS Plan could fit into your Medicare strategy.
Knowing Your Medicare Advantage Options
Under the various Private Fee-for-Service Plans, Medicare provides monthly payments to private insurers, which in turn determine how much to charge policyholders for various medical services.
Medicare Advantage Plans are optional Medicare plans offered by Medicare-approved private companies and available to people already enrolled in Medicare Part A and Part B. Medicare Advantage plans can provide additional coverage in various areas of health, and usually include prescription drug coverage. Among some popular Medicare Advantage plans are Medicare Private Fee-for-Service (or PFFS) Plans.
Private Fee-for-Service (PFFS) Plans allow you to receive services from any health care provider agreeing to the terms and conditions of your particular PFFS Plan. As a result, it’s important 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 also make a point of confirming your provider’s agreement to your plan’s terms and conditions every time you arrange a visit.
Joining a Medicare PFFS Plan does not affect your eligibility for all medically-necessary services covered by Medicare Part A and Part B.
Medicare Part A pays primarily for inpatient hospital services, skilled nursing facility care after a hospital stay, home health care, and hospice care. Plan B helps pay for medical expenses, clinical laboratory services, and outpatient hospital treatment. Coverage in these areas is not affected by enrollment in a PFFS Plan. You should be aware, however, that a PFFS Plan may not cover the cost of a procedure not deemed medically-necessary under Medicare, and this can result in high out-of-pocket costs for services your insurer deems unnecessary.
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.
We’re eager to answer any questions you may have about Medicare Private Fee-for-Service Plans. Contact MedicareMall now and let us put our two decades-plus of experience to work for you!
Resources: Your Guide to Medicare Private Fee-for-Service Plans [PDF]
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