The Basics Of PFFS Plans

blood transfusion - two heartsWhat Is A PFFS Plan And How Does It Work?

A Private Fee-for-Service (PFFS) Plan is a type of Medicare Advantage Plan (Part C). Private insurance companies offer them and they differ from Original Medicare or Medigap. These plans determine how much you have to pay and how much the insurer will pay doctors, other health care providers, and hospitals. Gathered is some must-know information about these plans.

Getting Healthcare: Under A PFFS Plan, you can get healthcare by going to any Medicare approved doctor, hospital, or other health care provider of your choice, as long as they accept the payment terms and agree to treat you (this includes specialists even if you do not have a referral). You do not have to choose a primary care doctor, just choose one when you need care.

Prescription Drugs: Most PFFS Plans offer coverage for your prescription drugs. If your plan does not, you can join a Medicare Prescription Drug Plan to get coverage for your medication.

Other Information:

  • In an emergency, the hospital, doctor, or other provider has to treat you. If it is not an emergency a care provider can decide whether to accept the plan’s payment terms at every visit. So even if they previously accepted them, they can choose not to on a different occasion.
  • You only have to pay the co-pay amount that is allowed by the plan for the type of service you are getting.
  • Some PFFS Plans have a network of providers who agree to always treat people who have the plan even if you have never seen the provider previously for any care.

Contact SeniorChoices NW in Wilsonville, Oregon to learn more about PFFS Plans today! We will go above and beyond to ensure you are receiving the protection you deserve, at the right price.

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