Private Fee-For-Service Plan

A Medicare Private Fee-for-Service Plan is a type of Medicare Advantage Plan offered by a private insurance company. 

It takes care of your Part A and B coverage as well as offering additional benefits.

Private Fee-for-Service (PFFS) plans determine how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care. 

This plan may or may not have a network. Be sure to ask your insurer. 

However, you will not have to have a primary care doctor or a referral to see a specialist.

Things to know about a Private Fee-for-Service plan

While you do not have to stay in network with this plan, you should always check with an out-of-network provider if they will accept your plan as payment. Other than emergencies, they can choose to accept or decline this plan on a case-by-case basis. 

Also, you only need to pay the copayment or coinsurance amount allowed by the plan for the type(s) of service you get at the time of the service.

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What does a Private Fee-for-Service plan cover?

Other than taking care of your Part A and B benefits, PFFS plans may also include coverage for:

  • Dental
  • Fitness memberships
  • Hearing
  • Nutrition programs
  • Over-the-counter drugs
  • Services for those with chronic conditions
  • Transportation to healthcare appointments
  • Vision
  • Wellness programs

What your plan covers will depend on where you live.

When you can enroll in Medicare Advantage plans

You can enroll in Part C when you first get Medicare. Medicare’s initial enrollment period is three months before you turn 65 and lasts until three months after. 

There is also an annual election period and an open enrollment period in which you can get an Advantage plan.

Medicare’s annual election period, or AEP, begins October 15 and runs through December 7 every year. 

Medicare Advantage’s open enrollment period is from January 1 through March 31. 

During this time you can switch to another MA plan or disenroll and go back to Original Medicare. 

There are also special election periods. 

These are triggered qualifying life events that allow you to make changes to your Medicare health coverage immediately.

Some examples that would qualify you for a special election period include unintentional loss of coverage, getting married, and moving out of your current plan’s area. But there are many things that would trigger a special election period.