Medicare Private Fee for Services # 10144
Medicare Private Fee for Services # 10144

Private Fee-for-Service (PFFS) Plans

A Medicare Private Fee-for-Service Plan is a Medicare Advantage Plan offered by a private insurance company. In a Medicare Private Fee-for-Service Plan,  Medicare pays a set amount of money every month to the private insurance company to provide health care coverage to people with Medicare on a fee-for-service arrangement. Also, the insurance company, rather than the Medicare Program, decides how much you pay for the services you get.  * Publication 10144  * 

  • PFFS enrollees may receive covered services from any provider in the U.S. who is eligible to provide Medicare services and agrees to accept the plan’s terms and conditions of payment.
  • Some PFFS plans contract with network provider.  If the PFFS plan has a network, enrollees may pay more if they see out-of-network providers.
  • Except for emergencies, enrollees must inform providers before receiving services that they are PFFS plan members so the non-network providers can decide whether to accept the plan’s terms and conditions.
  • Non-network providers may, on a patient-by-patient, and visit-by-visit basis decide whether to treat the beneficiary.
  • Non-network providers that accept Original Medicare may choose not to accept PFFS plan enrollees.

I’m not aware of any in CA



Publication 10144  Private Fee for Service


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