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What is a PFFS plan? |
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A private fee-for-service plan (PFFS) is a type of Medicare Advantage plan. |
These plans in urban areas must establish a network of providers. PFFS plans in rural areas do not have to set up networks Even though there may be a network available, those who elect a PFFS plan do not have to use those services. They can see any Medicare-approved provider who has agreed to accept the plan’s terms and conditions of payment. However, these services can cost more than in-network care. A PFFS plan cannot require prior authorization of services. Those with this coverage do not need to choose a primary care doctor. A PFFS plan include prescription drug coverage. If the plan does not offer this coverage, the beneficiary can purchase a stand-alone Part D drug plan. PFFS plans were once very popular. Between 2005 and 2006, enrollment increased almost 950%. By 2016, only about 1% of Medicare Advantage enrollees had PFFS plans. Today, there are a few plans sprinkled here and there. |
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Last updated: 12-06-2024