Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 2/5
A Private Fee-for-Service (PFFS) Medicare Advantage plan differs from an MA HMO because a PFFS plan:
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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 is a type of Medicare Advantage plan that generally has no provider network. The plan sets its own fee schedule and pays Medicare-approved providers at those rates on a fee-for-service basis. Providers may choose whether to treat a PFFS enrollee on a visit-by-visit basis. Because there is no network and no gatekeeper, PFFS plans are distinct from MA HMOs, which require network providers and usually PCP referrals. Like all MA plans, a PFFS plan must cover all Original Medicare benefits.
Why the other options are wrong
- B) A PCP referral system is characteristic of HMO-style plans, not PFFS plans, which generally operate without a gatekeeper or network.
- C) PFFS plans are open to anyone eligible for Medicare Advantage, not only those with employer-sponsored coverage.
- D) Every Medicare Advantage plan, including PFFS, must provide at least all Original Medicare Part A and Part B benefits.
Memory hook
PFFS = no network, pay-as-you-go. Any Medicare-approved doctor can treat, and the plan pays.