Private Fee For Service
In general, Medicare Advantage Plans have limitations when it comes to where and how you can get treatment, and whether they have prescription drug plans built-in.
A Private Fee for Service Plan:
- Allows you to get treatment from any doctor or healthcare facility that agrees to the plan’s payment terms. If so, it’s up to them to treat you (however, in emergencies they’re required to treat you)
- Doesn’t require you to choose a primary care doctor
- Doesn’t require you to get a referral to see a specialist
A Private Fee for Service Plan may or may not come with a built-in prescription drug plan. This depends on the specific plan you enroll in.
Defining Features of the PFFS Plan
With a Private Fee for Service Plan:
- There is a predetermined amount that you will pay for treatment(s). You only have to pay the coinsurance or copayment amount set by your plan. This amount can vary depending on the type of service you get at the time of treatment.
- You are issued a plan card, which you will need to show before receiving treatment
- It’s important to know which healthcare providers accept the plan’s payment terms. Staying within your network will always be less expensive
- You receive two letters each year. One is known as the “Evidence of Coverage”, which lets you know the finer details of your coverage itself, including your coverage amount. The other is known as the “Annual Notice of Change”, and it provides information about upcoming changes to your plan that will take effect the following January
- Evidence of Coverage will arrive by October 15 of each year
- Annual Notice of Change will arrive by September 30 of each year
Influential factors
The following may be make-or-break (in terms of pros and cons) for those interested in joining:
- Variability. The PFFS Plan available to you may lack prescription drug coverage, but then again, it may have prescription drug coverage
- Preference in payment. If you prefer to have a predetermined amount that you will pay for healthcare services, then this plan is for you
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Understanding Medicare Advantage Plans can be a complicated process, but we can help make it easier. Call us at 281-639-7787, or send us an email at [email protected] to get your coverage started.
