Private Fee For Service (PFFS)

A Private Fee For Service (PFFS) plan is a type of plan offered by private insurance companies in which the plan determines its payment schedule for doctors, hospitals, and other health-care providers as well as the amount you will pay to receive service. You have the choice to go to any Medicare-approved provider that accepts the plan’s payment terms and agrees to treat you. In a PFFS plan, you do not need to have a primary care doctor nor do you need a referral to see a specialist. Not all providers will accept Medicare’s fee schedule however, and those who do may decide at every visit whether to accept your plan’s terms and conditions of payment. Once enrolled in a PFFS plan, you cannot use your Original Medicare card for service as Original Medicare will not pay for your health care while you are enrolled in a PFFS plan. Your prescription drug coverage may be part of the plan’s offering but if not, you are eligible to enroll in a Medicare Part D Prescription Drug Plan.

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