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Medicare Advantage PFFS Plans


You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO, PPO, PFFS).

If you have Original Medicare, the government pays for Medicare benefits when you get them.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

Medicare pays these companies to cover your Medicare benefits.

If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage.

This is different than a Medicare Supplement Insurance (Medigap) policy.

Private Fee-for-Service (PFFS) plans

PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms.

The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to always treat plan members.

You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan’s terms, but your costs will usually be lower if you stay in the network.

PFFS – Private Fee For Service

 Private Fee-for-Service (PFFS) plans do not require you to choose a primary care physician nor require you to obtain a referral from your primary doctor to see a specialist.

PFFS plans may include prescription drug coverage.

If a PFFS plan does not offer coverage for your medications, you have the option to enroll in a stand-alone Prescription Drug Plan (PDP) Medicare Part D plan.

PFFS plans are one of the few types of Medicare Advantage plans that allows enrollment into a separate plan for prescription drug coverage, if it’s not already included.

Non-network Providers consider a PFFS plan’s payment terms for each service provided. In an emergency, doctors, hospitals, and other providers must treat you.