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