Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 3/5
A Private Fee-for-Service (PFFS) Medicare Advantage plan is characterized by:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
A PFFS plan is a Medicare Advantage type in which the plan sets its own payment rates for providers. Providers who have not contracted with the plan may decide, on a claim-by-claim basis, whether to accept the plan's terms for a given service; if they agree, the plan pays them its fee schedule. PFFS plans generally do not require a primary care gatekeeper or referrals, and members may see any provider willing to accept the plan's payment terms. The plan type is available to all Medicare-eligible beneficiaries, not only those under 65.
Why the other options are wrong
- B) PFFS plans typically do not require a PCP selection or gatekeeper referrals — that is an HMO/POS feature. The PFFS member generally needs no gatekeeper or referral under the plan.
- C) Members may use any provider willing to accept the plan's terms; PFFS is not confined to a small employed-physician network. Any willing provider may bill the plan case by case.
- D) PFFS plans are not restricted to beneficiaries under 65; they are open to all Medicare-eligible beneficiaries. All Medicare-eligible beneficiaries, of any age at all, may enroll in PFFS plans instead.
Memory hook
PFFS = the plan sets the price, and any willing provider can bill it case by case. No gatekeeper, no roster.