PFFS Plans

Private Fee-for-Service (PFFS) plans are another type of Medicare Advantage (Part C) plan. If you’re interested in learning more about the coverage you can get with a PFFS plan, we have outlined everything you need to know below.

How Do PFFS Plans Work?

PFFS plans will determine how much they will pay health care providers, hospitals, and doctors, as well as determine what you will pay when you get care. Depending on the PFFS plan, you may be able to get your care from any doctor, provider, or hospital. Other PFFS plans may have a network of providers. If you are in a PFFS plan that has a network and you choose to go outside of this network to receive your care, your plan may not provide coverage or you will have to pay more out-of-pocket.

You can typically go to any Medicare-approved doctor, provider, or hospital that accepts your plan’s payment terms and agrees to provide you with the care and services you need.

What Do PFFS Plans Cover?

Like other Medicare Advantage plans, PFFS plans will provide the same coverage as Original Medicare (Part A and B), and may also provide additional benefits, such as dental, vision, or hearing coverage.

Some PFFS plans may also cover prescription drugs. However, if your plan doesn’t cover prescription drugs, you can join a Medicare Part D prescription drug plan.

What Else Do You Need to Know About PFFS Plans?

With a PFFS plan, you don’t need to choose a primary care doctor. You also don’t need a referral to see a specialist.

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