Medicare Private Fee-for-Service (PFFS) Plans
A PFFS plan is a Medicare Advantage plan with payment terms set by the plan itself, where provider acceptance matters case by case rather than through a fixed network.
We can help you understand how provider payment works, what PFFS plans may cover, and what to check before you enroll.
How PFFS Plans Work
A PFFS plan includes all Medicare Part A and Part B benefits, plus potential additional services, but structures provider payment differently than an HMO or PPO — the private insurer sets its own reimbursement rates and member charges instead of using Medicare-set rates within a fixed network.
PFFS Basics You Should Know
No Defined Network
PFFS plans typically operate without a fixed provider network. Providers decide whether to accept the plan's payment terms each time you receive care.
No Referrals Needed
PFFS plans generally don't require a referral to see a specialist, giving you direct access without a gatekeeper.
Plan Sets Payment Terms
Unlike HMO or PPO plans where Medicare sets the rates, a PFFS plan sets its own payment terms and how much you pay for services.
Get Your Free PFFS Plan Quote
Answer a few questions and a licensed insurance agent will follow up — no cost, no obligation.
Check to see what benefits you are missing
Step 1 of 2 — Basic Info
How Provider Payment Works
You can see any Medicare-approved doctor or hospital that accepts the plan's payment terms and agrees to treat you. Unless a provider already has a contract with the plan, they can choose whether to accept those terms each time you receive care — so it's worth confirming before an appointment, not assuming it.
Eligibility
You must be enrolled in Medicare Part A and Part B and live in the plan's service area to enroll in a PFFS plan.
Additional Benefits
Many PFFS plans add dental care, vision exams and glasses, hearing services, and prescription drug coverage (Part D) — benefits not available under Original Medicare.
Cost Components
Monthly premiums vary by plan, with some $0 premium options available. An annual out-of-pocket maximum caps what you'll pay for covered services in a plan year.
Frequently Asked Questions
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Get help comparing PFFS plans against other Medicare Advantage options. There is no cost and no obligation.