Under a Medicare private fee-for-service (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 Medicare Advantage product in which the plan sets its own payment rates and terms for providers rather than paying Medicare-approved amounts. Medicare pays the plan a capitated amount, and the plan decides how much it will pay doctors and hospitals; any provider willing to accept the plan's terms can treat a member, but providers are not required to accept the plan and may decline. There is no network and no gatekeeper requirement, but deductibles and copayments still apply. The opt-in provider structure of PFFS is a defining Medicare Advantage type tested in the senior products outline.
Why the other options are wrong
- B) PFFS plans have no gatekeeper; members may see any provider willing to accept the plan's terms.
- C) Providers may decline to accept PFFS plan payment terms; acceptance is voluntary.
- D) Cost-sharing exists under PFFS plans just as under other Medicare Advantage products.
Memory hook
PFFS sets its own price tag; the doctor can take it or leave it.