Private Fee For Service
How Do Medicare Advantage Plans Work?
Medicare Advantage plans are health care insurance plans that are supplied by private insurance companies who have contracted with Medicare to administer Original Medicare benefits. Each insurance company can choose what types of plans they wish to offer, and there are a range of options on the market currently. PFFS plans are only one option currently available, with HMO and PPO being two of the others.
What Is A Private Fee-For-Service Plan?
With a PFFS plan, your insurance provider sets predetermined rates that they will pay doctors and other health care providers for services that their plan’s participants receive. Therefore, your insurance company will negotiate with health care providers to convince them to accept their listed rates. If a medical professional accepts the terms of your plan, your treatment is covered, even if they are not members of your plan’s network. Still, health care costs are typically lower if you receive treatment strictly within the network.
PFFS Plan Rules
You do not need a primary care doctor to see a specialist when enrolled in a PFFS plan. Some PFFS plans have a network of providers that have agreed to see any plan member, even if they’ve never seen that patient before. If a doctor or other health care provider decides they do not want to treat you they have the freedom to not do so. Though, if a provider does agree to treat you, make sure that they have also accepted the payment terms offered by your insurance provider. If you are hurt in an emergency, health care professionals must administer treatment to you, regardless of whether they’ve accepted your plan’s terms.
PFFS Plan Costs
The typical PPFS plan requires you to pay a Part B premium and a Part C (Advantage) premium. You will also need to pay coinsurance, copayments, and deductibles depending on the nature of your policy. To lower costs, seek treatment solely within your plan’s network.