Medicare PFFS plans are one of the many types of Medicare Advantage plans. They were created in 2006 as a way to offer more choices to beneficiaries.
PFFS plans are offered by private insurance companies, and they allow you to choose any doctor or hospital that accepts Medicare.
We will discuss what PFFS plans are, how they work, and who should consider them.
Integrity Now Insurance Brokers is a license Medicare insurance agent who can help you decide if a PFFS plan is right for you!
If you join a Medicare PFFS plan, you agree to pay the plan’s premiums as well as copays and coinsurance for medical services as outlined in the plan.
The thing that makes these plans different from an HMO or PPO is that you are not limited to any certain network of providers.
You can also use doctors and hospitals outside of the United States if they accept Medicare payment!
If you are someone who likes to have the freedom to choose your doctor and hospital, then a Medicare PFFS plan might be right for you. These plans can also be a good option if you travel frequently or if you live in an area with limited provider options.
Medicare PFFS plans two most common features are:
A separate Part D drug plan is not required if you participate in a Medicare PFFS plan that includes a prescription drug plan as part of the coverage.
You may pick a Medicare PFFS plan that includes a built-in drug plan or one that offers “medical only” coverage and enroll in a different prescription drug plan.
When selecting a Medicare PFFS plan ensure you understand if the plan includes Part D coverage or if you need to obtain a standalone plan. You will also want to compare drug costs for both the built-in drug plan and a standalone Part D plan.
If you are interested in learning more about Medicare PFFS plans, or if you would like help finding a Medicare insurance agent, please contact us today! We would be happy to answer any of your questions. Thanks for reading!
The benefits provided by PFFS must be identical to those offered by Original Medicare Part A and Part B. The way you finance your share of medical expenses is different.
For example, if you need hospitalization, your PFFS payments a daily copay for a specific number of days. Each benefit period has its own deductible under Original Medicare Part A.
Coverage for Part A and B includes:
PFFS plans also may include services that Medicare does not cover:
To be eligible for a Medicare Advantage PFFS plan, you must fulfill the following conditions:
The average cost for a Medicare PFFS plan is around $100 per month. This is above and beyond the cost of your Part B monthly premium. You may also incur costs for your Part D prescription drug plan if it is not included within the PFFS plan.
Outside of the monthly premium, you will also incur costs when you use the plan, including:
The cost of a policy varies by state, so it’s vital to compare the coverage choices accessible in your region for an accurate price range.
The best time to sign up for a Medicare supplement plan is during the guaranteed issue period. This is typically when you are about to turn 65 and become Medicare eligible.
If you sign up for a Medicare advantage plan first and you fall outside of the guaranteed issue period, you may be required to go through medical underwriting.
Unlike Medicare advantage plans, Medigap plans are not guaranteed issue plans. This is often why people choose a Medicare PFFS plan as their medical history prevents them from selecting a Medigap plan.
If you fall under the guaranteed issue period or you are healthy, a Medicare supplement Plan G or Plan N could be a better option over a Medicare Advantage PFFS plan.
Depending on the Medigap plan selected, your cost could be substantially lower than a Medicare PFFS plan. This is because Medigap plans cover most of your medical cost and do not add higher cost for seeing out of network doctors.
Medigap plans do not have a medicare provider network, and are considered an open access plan.
When comparing the monthly premium of a Medicare PFFS plan and a Medicare supplement plan, the costs of these plans change from location to location. The pricing for a Medicare supplement plan may include pricing related to a person’s age.
A Medicare PFFS plan are not age banded, so they will not increase as you become older.
Most Medigap plans are age banded plans, which means as you age the premium may increase. This means the monthly premiums for both plans may be similar today at age 65 but at 75 the Medigap plan may cost more.
Outside of the monthly insurance premiums for a Medigap plan and a Medicare PFFS plan, you will need to factor in the plans copays, deductibles, coinsurance, and max out of pocket cost.
For instance a Medigap Plan G a Medicare beneficiary is only responsible for the Part B annual deductible. All other Medicare eligible cost are covered at 100%.
Where Medicare PFFS plan could change you thousands of dollars as you use the plan for your medical needs.
All costs associated with these plans should be carefully evaluated before making any decisions.
Integrity Now Insurance Brokers is a nationwide Medicare insurance agency specializing in Medicare advantage plans and Medicare supplement plans..
Our Medicare insurance agents are licensed and certified through a national organization known as AHIP. They are required to recertify on Medicare annually to ensure they are up to date on any changes.
