How do Private Fee-for-Service (PFFS) plans deliver benefits to Medicare beneficiaries?

Like Original Medicare, PFFS plans pay providers on a fee-for-service basis. A provider submits a claim to the PFFS plan after providing a service. The plan pays the provider at a rate set by the plan. Like Original Medicare, PFFS members can access any provider who is willing to accept the plan's payments. 

Like other Medicare Advantage (MA) plans, PFFS plans must cover all Part A and Part B services, and may set their own deductible and co-insurance charges. Like other MA plans, they may offer covered services in addition to those in Original Medicare. However, PFFS plans are not managed care plans like HMOs. For the most part, they do not maintain provider networks.

For more information, please refer to HAP’s chart, The Highlights: Medicare Advantage - Private Fee-for-Service Plans and HAP’s fact sheet, Types of Medicare Advantage Plans.

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