Medicare Advantage Private Fee-for-Service
What is Medicare Private-Fee-for-Service and what does it cover?
Medicare Private-Fee-for-Service (PFFS) is a Medicare Advantage plan offered by a United States Medicare-certified private insurance company. It offers more benefits than Original Medicare and it may include the following benefits:
- Chronic condition healthcare services and support
- Adult day-care services
- Dental, vision, and hearing
- Fitness, nutrition, and wellness programs
- Over-the-counter drugs
- Doctor’s appointment transportation
How a Medicare Private-Fee-for-Service plan works
Here are important things you should know about Medicare PFFS plans:
- Health service rates
Medicare does not determine how much you pay for healthcare when it comes to PFFS plans. Your Medicare private insurance company decides how much money it will pay your healthcare provider and how much you pay out-of-pocket.
- Healthcare provider networks
Medicare PFFS plans may come with healthcare provider networks and you may get out-of-network healthcare if your healthcare provider agrees with your payment terms and conditions.
- Original Medicare enrolment
Only people with Medicare Part A and Part B coverage are eligible for Medicare PFFS plans.
- Medicare Part B premiums
You have to pay your Medicare Part B premiums and PFFS premiums separately to receive benefits.
- Primary Care Physicians
Medicare PFFS plan beneficiaries do not have to choose a primary care physician, unlike HMO plans.
- Referrals
With Medicare PFFS plans, you do not need a referral from your primary care physician to see a specialist.
- Advance coverage decision
You can ask for an advance coverage decision for medically necessary healthcare services not covered by your PFFS plan.
Medicare Private-Fee-for-Service Enrolment periods
To join Medicare Private-Fee-for-Service plans, you can enroll within any of the following periods:
- Initial Coverage Election Period
This period is open for seven months, and it falls between the three months before your 65th birthday and three months after your 65th birthday month.
For young people living with a disability, however, you become eligible for Medicare benefits 25 months after you first start receiving Social Security Benefits. Your enrolment period will be open between the three months before and three months after the month you become eligible.
- Annual Election Period
The Annual Election Period is open from October 15th to December 7th and your Medicare Medical Savings Account coverage will begin on the 1st of January the following year.
- Medicare Advantage Open Enrolment Period
Medicare Advantage beneficiaries can change their plans or migrate to Original Medicare during this period.
- Special Election Period
These are open on an individual basis when exceptions are made for instances such as changing your Medicare Advantage coverage area or moving into a nursing home occur. During this period, you can change your Medicare plan to suit your requirements.
Finding the right PFFS Medicare Advantage plan
You need to understand what your Medicare Private Fee-For-Service plan covers before you enroll.
At Your Life Agency, our certified Medicare insurance agent will help you compare the cost of Medicare Advantage plans, to find the one that provides you with the most benefits within your budget. Moreover, we go the extra mile by helping you with your Medicare enrolment to make the process easier for you.