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Medicare Advantage PFFS (Private Fee-for-Service) plans are a type of Medicare Advantage plan offered by private insurance companies. PFFS plans operate differently from traditional Medicare and other Medicare Advantage plan types. Here’s an overview of Medicare Advantage PFFS plans:
With PFFS plans, you can choose any healthcare provider if they accept the plan’s payment terms and conditions. This means you can see any doctor, specialist, or hospital that agrees to treat you and accepts the plan’s payment terms. However, not all providers accept PFFS plans, so confirming with each provider before seeking care is essential.
PFFS plans do not have a network of providers that you must use. This can be advantageous if you prefer to have the freedom to see any Medicare-approved provider who accepts the plan’s terms, regardless of their network participation.
PFFS plans decide how much they will pay for healthcare services, and providers who agree to these terms can treat you. The plan sets the payment rates, and providers can accept or decline the plan’s payment terms on a case-by-case basis. To avoid unexpected costs, it’s crucial to ensure that your healthcare providers accept your specific PFFS plan before receiving care.
PFFS plans may offer additional benefits beyond Original Medicare, similar to other Medicare Advantage plans. These benefits may include prescription drug coverage, vision care, dental care, hearing care, wellness programs, and other services.
PFFS plans generally do not require referrals from a primary care physician (PCP) to see specialists. However, some services may require prior authorization from the plan before receiving the care.
PFFS plans generally charge a monthly premium. Not only will you have to pay this premium, but you are also expected to keep up with your Part B monthly premium.
At Delta Medicare Benefits Group, we will review all your available coverage options and ensure that the plan you choose aligns with your healthcare needs.
Call us today to learn more about what we can do for you and if a PFFS plan meets your needs!
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