Private Fee-for-Service (PFFS) plan

Can I get my health care from any doctor, other health care provider, or hospital?

You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan’s payment terms and agrees to treat you. If you join a PFFS plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan’s terms, but you may pay more.

Are Part D Rx Prescriptions covered?

Sometimes. If your PFFS plan doesn’t offer drug coverage, you can join a Medicare Prescription Drug Plan to get coverage.

Do I need to choose a primary care doctor?


Do I have to get a referral to see a specialist?


What else do I need to know about this type of plan?

• PFFS plans aren’t the same as Original Medicare or Medigap.
• The plan decides how much you pay for services.
• Some PFFS plans contract with a network of providers who agree to always treat you, even if you’ve never seen them before.
Out-of-network doctors, hospitals, and other providers may decide not to treat you, even if you’ve seen them before.
• For each service you get, make sure to show your plan member card before you get treated.
• In a medical emergency, doctors, hospitals, and other providers must treat you.
• If you need more information than what’s listed on this page, check with the plan.

Read more in Medicare & You – link in side panel

Medicare and You 2020 #10050  
Everything you want to know - Read Along

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