In a Medicare Advantage Private Fee-for-Service (PFFS) plan, a member may generally:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
A Private Fee-for-Service (PFFS) plan pays providers at amounts set by the plan, and members can generally obtain care from any Medicare-eligible provider that agrees to accept the plan's terms and conditions for each visit. There is no gatekeeper and typically no network requirement, though a plan may have a network of providers who contract to accept its rates. This distinguishes PFFS from HMO and PPO structures within Medicare Advantage. Before receiving services, the provider must be willing to accept the plan's payment amount and conditions for that specific service, and the member should present their PFFS card. Because network participation is voluntary per visit, members should confirm provider acceptance in advance to avoid unexpected bills.
Why the other options are wrong
- B) PFFS plans do not use a primary care gatekeeper; members choose their own providers.
- C) PFFS members can use any willing provider; it is the HMO or EPO model that excludes out-of-network care.
- D) Providers are independent practitioners who accept the plan's terms; they are not employed by the plan.
Memory hook
PFFS = pay me, treat me: any provider who accepts the plan's fee is in-network that day.