PFFS (Private Fee For Service)

PFFS plans allow you to see any Medicare-approved doctor, hospital, or other health care provider that accepts the plan’s payment terms and agrees to treat you. Under a PFFS you do not need a referral to see a specialist. Some PFFS plans have networks. Be aware that If you join such a plan, you may also see any of the network providers who have previously agreed to service plan members. Out of network doctors, hospitals, and other providers who accept the plan’s terms may also be chosen, but you may have higher costs. Check with the plan for more information.

 

Drug coverage is not always included in a PFFS plan.  If your plan does not include drug coverage, you may want to enroll in a Medicare Prescription Drug Plan (Part D) that includes drug coverage. Check with the plan for more information.

 

Keep in mind that a PFFS plan is not the same as Original Medicare. The cost for services is established by the plan. Some PFFS plans have contracted with providers who have agreed to always treat you, even if they have never treated you before. By the same token, out-of-network providers may decide not to treat you, even if they have treated you before. Before you obtain service from a doctors, hospitals, or other providers be certain that those doctors, hospitals, and providers agree to treat you under the plan and accept the plan’s payment terms. In case of emergency, doctors, hospitals and other providers are required to treat you, by law. In emergency situations, go to your nearest hospital.