PFFS stands for Private Fee For Service. A PFFS plan is a type of Medicare Advantage plan whose coverage can, in many ways, offer you the most flexibility. The selection of doctors is wider and the benefits covered are quite extensive. Inpatient and outpatient services, equipment and home health services all are covered, as are preventative services and diagnostic testing. Ohio Health Benefits has an excellent choice of PFFS plans to choose from.

How does a PFFS plan work?

A Medicare Advantage Private Fee for Service plan works differently than a Medicare supplement plan. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to you, except in emergencies.

What are the advantages of a PFFS plan?

The main advantage of PFFS plans is that you are free to see any doctor or specialist you choose as long as he or she accepts Medicare payments and agrees to our terms and conditions. There is no network that you must limit yourself to. There are also no referrals needed to see a specialist.

What are the costs?

Whenever you visit a doctor or have a medical service performed, you’ll have an out of pocket co-pay just like most other plans. You will also have a monthly premium to pay and prior authorization may be required for some treatments. In general, the increased amount of choices you receive means you may have a higher out of pocket cost.

Who should choose a PFFS plan?

If seeing the doctor of your choice, and not being limited to a network is important to you, then a PFFS plan might be right for you. Also, if the wellness programs that are a part of other plans are not very important to you a PFFS may be a good choice. Keep in mind the higher costs, however.

Who is eligible?

You are eligible for a PFFS plan if you are entitled to Medicare Part A, (of if you enrolled in Part B and do not have end-stage Renal Disease), if you live in the plan’s service area and if you do not have other coverage that would pay for services before your deductible is met.

How do I choose a PFFS Plan?

The best way to choose is to compare coverage and rates. At Ohio Health Benefits we feel we have created some of the most extensive and affordable PFFS plans available today. We invite you to find out more about them.