August 9, 2010
Medicare Private Fee-For-Service (PFFS) Plans
What is a PFFS Plan?
PFFS refers to "Private Fee-For-Service" and applies to Medicare Advantage plans where a payment is made to a health care provider for each service provided.
Advantages of a PFFS Plan
Unlike an HMO, a PFFS plan does not require you to choose a primary care doctor. Accordingly, a member of a PFFS plan does not need a primary care doctor's referral to see a specialist. Additionally, a PFFS plan is not limited to a network of providers as is the case for both HMOs and PPOs. The absence of a network means that you can use any Medicare-approved doctor or hospital that accepts the plan's terms of payment. However, health care providers consider a PFFS plan's payment terms for each service so a doctor may accept the plan to treat one case but later refuse the plan to treat a different case.
Issues to Consider When Selecting a PFFS Plan
Like HMO and PPO plans, PFFS plans involve trade-offs. They offer freedom to see specialists without referrals and do not have network limitations but they also come with the prospect of confirming that your health care providers will accept the insurance before they treat you. Accordingly, you should consider the following issues:
- For each health care service, you will need to confirm that the doctor or hospital providing the service will accept the plan's payment terms
- Health care providers may decide not to treat your case even if you've seen the provider previously
