Private Fee For Service (PFFS)
Private-Fee-For-Service (PFFS) plans are perfect for those who only want to pay for the coverage they need. As the name implies, you only pay for medical services as you use them.
How Do PFFS Plans Work?
Private-Fee-For-Service (PFFS) plans are a flexible and affordable form of Medicare Advantage. Rather than relying on a network of providers and consistent month-to-month payments, you instead choose doctors who accept the plan and pay for the services and equipment you use.
A Medicare Private Fee-For-Service (PFFS) Plan allows you to pay on an as-needed basis. As a result, you are only required to pay the copayment or coinsurance of the plan when you receive care. With HMO or PPO plans, your monthly premium would account for this cost.
The cost of the copayment and coinsurance fees are dependent on the plan, the service being used, and the healthcare provider. Also, unlike HMO and PPO plans, there is no preferred network, meaning the price of coverage will vary between individual healthcare providers.
Coverage and Benefits
PFFS plans offer the greatest overall healthcare provider options, in or out-of-network and features all benefits of medicare advantage. Most plans include prescription drug coverage—if it does not, you have the option to add Medicare Part D to your plan, unlike HMO and PPO. Your choice of plan is, of course, dependent on your personal needs and preferences.
PFFS vs. HMOs vs. PPOs
Medicare Advantage Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), and Private-Fee-For-Service (PFFS) plans all feature the benefits of Medicare Advantage. The method of payment and way you receive this care, however, varies between each plan.
If you prefer having the consistency of a primary care doctor that refers you to the specialists and prescriptions you need, an HMO plan may be best for you. This plan has the smallest coverage options, but the lowest cost of the three.
If you prefer having access to out-of-network doctors, then a PPO may be better suited for you. This plan will work well for you if you travel and want less expensive care more regularly.
PFFS plans offer the greatest overall healthcare provider options, in or out-of-network. Most plans include prescription drug coverage—if it does not, you have the option to add Medicare Part D to your plan, unlike HMO and PPO. Your choice of plan is, of course, dependent on your personal needs and preferences.