Medicare Advantage Plans overview
Medicare Advantage Plans are not a single entity, although they may be implicitly referred to as such when discussing Medicare Advantage as a whole.
In general, these plans are appealing to those who want all-in-one coverage. Medicare Advantage, or Part C, is like a package that consists of Medicare Parts A, B, and D. There are small differences between each type of Medicare Advantage Plan, which is worth close examination before deciding upon which one you wish to acquire.
What does it cover?
A Medicare Advantage Private Fee-for-Service (PFFS) Plan is unique in that it doesn’t require you to choose a primary care physician, nor do you have to get a referral when you need to see a specialist. Typically, Medicare Advantage Plans require choosing a primary care physician, with that doctor’s referral if you need to go to a specialist.
You will be able to get coverage for all services offered by Original Medicare, plus additional services not covered by Original Medicare. Some plans may allow you to get care out-of-network, but that will come at a higher expense. Others do not allow you to see doctors outside your plan’s network.
In some cases, out-of-network doctors who have treated you in the past may refuse treatment later on. That being said, out-of-network doctors are required to treat you if you’re in an emergency situation.
How do they work?
The biggest difference between PFFS Plans and other Medicare Advantage Plans is how the plan provides coverage. With a PFFS Plan, the insurance company will determine just how much it will pay the healthcare provider and how much you will pay for a health service. If you receive a service that is not medically necessary or covered, you can request an “advance coverage decision.” You may also have to confirm with your healthcare provider to ensure if they will accept your plan’s terms.
With other Medicare Advantage Plans, Medicare sets those rates instead.
Also, for some Medicare Advantage Plans, such as HMO or PPO, you cannot add a Part D plan if they do not include Part D coverage. However, you can do so with a PFFS Plan if it does not have Part D coverage.
Is PFFS right for you?
If you have any questions or concerns regarding PFFS Plans and how you may be eligible, contact us today by calling 800-805-6834.
