Private Fee-for-Service (PFFS)
A PFFS plan is a type of Medicare Advantage plan that sets its own payment rates. You can see any Medicare provider who agrees to the plan’s terms, and the plan determines how much it pays and what you pay.
Understanding Private Fee-for-Service (PFFS)
A Private Fee-for-Service (PFFS) plan is a type of Medicare Advantage plan in which the plan — not Medicare — decides how much it will pay providers and how much you pay for services. Depending on the plan, you may be able to see any Medicare provider who agrees to accept the plan's payment terms, or you may have a defined network.
For beneficiaries, PFFS plans can offer flexibility in choosing providers, but with an important catch: providers are not required to accept the plan, and they can decide on a visit-by-visit basis. That makes it essential to confirm, each time, that a provider will accept your PFFS plan before you receive care.
For example, your regular doctor might accept your PFFS plan in January but decline it later in the year, leaving you to find another provider or pay out of pocket. Always verify acceptance before each appointment.
Have questions about Private Fee-for-Service plans? Get a free Medicare review and we will help you weigh PFFS against HMO and PPO options.
Related Terms
Medicare Advantage
Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans include Part A, Part B, and usually Part D coverage in one plan.
Health Maintenance Organization (HMO)
An HMO is a Medicare Advantage plan type that generally requires you to use in-network providers and choose a primary care doctor, with referrals to see specialists. Out-of-network care is usually covered only in emergencies.
Preferred Provider Organization (PPO)
A PPO is a Medicare Advantage plan type that lets you see any provider, with lower costs in-network and higher costs out-of-network. PPOs generally do not require referrals to see specialists.
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