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Senior Health>Medicare Insurance
Private Fee For Service Plans (PFFS)>> |
Medicare
Advantage Private Fee for Service Plans
Private Fee for
Service (PFFS) plans are offered by private insurance companies to Medicare
eligible beneficiaries. They are very simliar in nature to other Medicare
Advantage plans, with the principal difference that doctor selection is much
wider.
What do they
cover?
Benefits are usually quite comprehensive, but will vary by plan. Many will begin
to offer an outpatient Prescription Drug benefit as part of the Medicare Part D
reforms. Inpatient and outpatient services, equipment and home health services
are covered to varying degrees, as are preventative services, diagnostic testing
and other services.
How much do they
cost?
Medicare Advantage PFFS plans sometimes have a monthly charge in addition to the
Part B payment to Medicare. However, there are a number of new plans with $0 per
month additional charge. The beneficiary pays for services per the plan?s
individual schedule of co-payments or co-insurance.
What are
specific advantages?
PFFS plans have a very important advantage over other types of plans- breadth of
medical provider network. Enrollees have the freedom to choose any doctor who
accepts Medicare payments. There are also no referrals needed to see
specialists, and no Primary Care Physician is required.
What are
specific disadvantages?
There are co-payments, similar to all Medicare Advantage plans. There is also
the possibility of Prior Authorization being required for some treatments.
Generally, the increased choice comes with a high out of pocket cost. Finally,
the enrollee receives none of the wellness program benefits or coordinated care
benefits that are an integral part of Managed Care plans.
For whom are
they appropriate?
In general, Medicare Advantage PFFS Plans are appropriate for patients for whom
a) Medicare Advantage is the best way to cover health care expenses (vs. Medigap
plans);
b) freedom to choose their doctors is a primary concern;
c) the coordinated care and wellness program benefits are not very important
How do I select the right plan?
In any case, selecting the right plan is a complex process that should take into
consideration a number of factors specific to the beneficiary.
Put
eBenefitsByDesign.com to work finding
your plan.To compare your Medicare health plan choices, please call
our toll free number or
Complete
our Medicare Information Request Form.
If you have questions call our Toll Free Number
@ 888.995.2821.
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