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Medicare Private Fee-for-Service Plans are fee-for-service plans offered by private companies. The general rules for how Medicare Private Fee-for-Service Plans work are below:

  • You can go to any Medicare-approved doctor or hospital that accepts the terms of your plans payment.
  • You may get extra benefits not covered under the Original Medicare Plan, such as extra days in the hospital.
  • The private company, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get.
  • If you’re in a Medicare Private Fee-for-Service Plan, you can get your Medicare prescription drug coverage from the plan if it’s offered, or you can join a separate Medicare Prescription Drug Plan to add prescription drug coverage if drug coverage isn’t offered by the plan.

How Do Private Fee-For-Service Plans Work?
Under Private Fee-For-Service, you may go to any licensed doctor or hospital in the U.S. that is willing to provide care and accepts the plans terms of payment. A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to agree to accept the plan's terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept the payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan's terms and conditions on the plan's website.

Does a Private Fee-For-Service Plan Cover Everything That Original Medicare Covers?
Yes. By law, a Private Fee-For-Service plan must provide enrollees with all of the benefits they would receive under Original Medicare. However, PFFS plans provide coverage that goes beyond Original Medicare in many areas such as 100% coverage for preventive care and $100 benefits annually towards eyewear and hearing aids.

Can I Use the Same Doctors and Hospitals That I Use Now, or Do I Need to Use a Network of Physicians?
Under Private Fee-For-Service, you can see any licensed provider who is willing to accept the Medicare Private Fee-For-Service plans terms and conditions of payment. You are not locked into a network of providers and you do not need a referral for covered services.

What If My Provider Won’t Accept My Private Fee-For-Service Plan?
Providers are not required to provide services to enrollees in a Medicare Private Fee-For-Service plan. If your provider currently bills Medicare, he or she will receive the same reimbursement from Private-fee-for service plans as Original Medicare. If your providers do not want to accept the plans terms and conditions of payment, you should seek care from another provider who is willing to provide services to Private Fee-For-Service members.

Do I Have to Go Through a Primary Care Doctor like an HMO?
No. Under Private Fee-For-Service, you can obtain care directly from any licensed providers who are willing to accept the Medicare Private Fee-For-Service plans terms and conditions of payment.

Do I Need to Continue to Pay My Medicare Part B Premium with Private Fee-For-Service?
Yes. You must continue to pay your Medicare Part B premium.