Fee-for-Service

Lets the member see any Medicare-eligible provider who agrees to accept the plan's payment terms and conditions — A PFFS plan is a type of Medicare Advantage plan that sets its own payment amounts for services. Members may receive care from any Medicare-eligible provider willing to accept the plan's terms; if a provider agrees to treat the member, it is paid according to the plan's fee schedule. PFFS plans do not necessarily require a gatekeeper or network, though some use networks to control costs. The any-provider-willing-to-accept-plan-terms feature distinguishes PFFS from HMO-style MA plans. The defining feature of a PFFS plan is that it sets its own payment amounts and terms for each service, and any Medicare-eligible provider who agrees to treat the member under those terms can be used. If the provider does not accept the plan's conditions, the member may be responsible for the full charge, which is why members should verify acceptance in advance.

National insurance concept

May receive covered services from any Medicare-approved provider that agrees to accept the plan's payment terms — A Medicare Advantage Private Fee-for-Service (PFFS) plan sets its own payment rates and pays providers on a fee-for-service basis. Members may obtain covered services from any Medicare-approved provider that is willing to accept the plan's terms and conditions of payment. Unlike HMO plans, a PFFS plan generally does not require a primary care physician or referrals. The plan, not a network, determines how much providers are paid.

National insurance concept