What is a Medicare PFFS plan?

PFFS stands for Private Fee-for-Service. This type of plan is a type of Medicare Advantage plan.

If you join a Medicare PFFS plan, you agree to pay the plan’s premiums as well as co-pays and coinsurance for medical services as outlined in the plan. What makes these plans different from coordinated care plans like HMOs and PPOs is that you are not restricted to a provider network.

With this plan, you just need to show your plan card to a provider before getting service. However, before treatment, the provider must agree to accept the plan’s payment terms and conditions and bill the plan.

Two common features about Medicare PFFS plans are:

  • You can seek treatment from ant Medicare-participating provider in the U.S. as long as they accept the plan.
  • You can choose a PFFS plan with a built-in drug plan or a “medical only”  plan with a separate drug plan

Keep in Mind

A Private Fee-for-service plan is NOT Medicare supplement insurance. Providers who do not contract with the plan are NOT required to treat you except in an emergency. This puts the responsibility on you to discuss with providers whether or not they accept and bill your plan.