A Private Fee-for-Service (PFFS) Medicare Advantage plan is best described as a plan that:
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
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.
Why the other options are wrong
- A) A gatekeeper and referral requirement describes an MA HMO, not a PFFS plan. PFFS plans generally require no gatekeeper or referral; members may see any provider willing to accept the plan's payment terms.
- B) A closed network of employed physicians describes a staff-model HMO, not PFFS. A closed network of employed physicians describes an HMO or staff-model plan, not the open-provider design of PFFS.
- C) PFFS plans are offered by private insurers approved by Medicare, not administered by the federal government. PFFS plans are offered by private insurers under contract with Medicare; they are privately administered, not federally run.
Memory hook
PFFS = find any Medicare doctor willing to take the plan's check.