Medicare Advantage PFFS Plans

A PFFS plan is exactly what it sounds like – paying a fee for the service. In this case, the insurance company pays the provider a fee for the service provided to the patient. The patient will pay a monthly premium just like any other insurance plan. When they see the doctor, the insurance company will reimburse the doctor at a rate for different services previously negotiated by the doctor and the insurance company. PFFS plans allow patients the ability of seeing out-of-network providers as long as the providers have not opted out of Medicare or out of a PFFS. Some PFFS plans do not even have networks, making flexibility a key component to PFFS plans.


The pros of a PFFS plan include the flexibility. Some of these plans will allow you to see doctors out-of-network as long as the providers have not opted out of Medicare and PFFS plans. Additionally, some PFFS plans include vision, hearing, and prescription drug coverage.


The major disadvantage of a PFFS is the preparation work required to make sure that a provider is a participant. For example, let’s say that you want to see a doctor out-of-network. You have to submit an advance organization determination to see if your services will be covered and to see whether the doctor accepts a PFFS. This requires a lot of planning in advance.

Medicare PFFS Summary

PFFS plans may be the right option for certain people. However, not all states offer PFFS plans. If you would like to see whether a Medicare PFFS is the right Medicare option for you, give us a call today!

We are committed to helping you realize your health and financial goals by making you aware of all your options so that you can make the best choice for yourself and your family.

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