Medicare Recipients Need to Look Carefully at Private Fee-For-Service Plans      

Private Fee-For-Service Plans are Medicare Supplemental Plans that are offered by private insurance companies as part of Medicare Advantage.  There are some policies that are excellent and offer good coverage but not all of them offer what individuals need.  Though many plans sound great, it is essential that Medicare recipients thoroughly research any plans that they are thinking about purchasing.

The way that Private Fee-For-Service (PFFS) plans work is that Medicare pays insurance companies for coverage for Medicare recipients.  The Medicare recipient can then go to any Medicare-approved provider who will accept the plan’s payment.   The important difference between PFFS and original Medicare is that there is no limit to the co-payments, nor is there a limit to the premiums that can be charged.  This is an area that it is very important to look closely at, because this means that the Medicare recipient in this situation will have to share a portion of the costs involved and this can add up.  Medicare allows providers to charge up to 15% above the plan’s payment amount for services.

The Medicare Rights Center has reported that even though the plans seem like they have some advantages, there are often more disadvantages with Medicare Advantage than the older, original basic Medicare.  Care can be more expensive due to higher co-payments, and many doctors and health care centers that accept basic Medicare as payment will not accept Medicare Advantage. 

Another issue is that Medicare Advantage has been looked at very closely because of aggressive – and sometimes fraudulent – marketing and sales practices.  Many Medicare recipients are being pressured and tricked into changing coverage, and, as a result, have been put in a situation where they are not better off at all.  In fact, in many cases, they are receiving a plan that does not cover them as well as the coverage they are replacing.

If you are thinking of enrolling in a PFFS plan, it is important to do some research to be sure it is legitimate and advantageous.  One of the best ways to protect yourself is to look at the cost of co-pays, premiums and extra coverage and make sure you can afford them.  Also, be sure you are comfortable with the individual and company you are buying from, and don’t hesitate to check them out. 

To be certain that you are purchasing what you truly need, contact Medicare at www.medicare.gov, www.cms.gov , or call them at 1-800-MEDICARE to talk to trained individuals who will answer your questions and help you to look carefully and understand the coverage you have now and the coverage that is proposed.

Entry Filed under: General-Medicare