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These plans are required by Medicare to provide the same level of coverage as Original Medicare. However, Private Fee-for-Service (PFFS) plans offer additional benefits not provided by Medicare.
With a Private-Fee-for-Service (PFFS) plan, you don’t need to choose a primary care physician nor do you need a referral to see a specialist.
This is how it operates:
The biggest difference with this plan is that the insurance company determines how much it will pay your healthcare provider and how much you pay for a covered health service. With other plans, Medicare sets these rates.
A PFFS plan is a type of Medicare Advantage plan. This means it offers additional benefits that Original Medicare does not.
Such benefits can include:
Benefits you are eligible for will depend on your area and plan providers.
Typically, this plan does include a Part D plan. If not, you’ll need to join a standalone Part D plan if you want prescription drug coverage.
Most notably, the biggest difference with this plan is that the insurance company determines how much it will pay your healthcare provider and how much you pay for a covered health service. With other plans, Medicare sets these rates.
But here is the key differences between PFFS and other Medicare Advantage plans:
It is important to talk with a licensed Medicare insurance agent at The Medicare Solutions Team to explain key differences in plans available in your area before coming to a decision on what’s right for you.
Initial coverage election period — Your initial coverage election period is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65. If you are under 65 and receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If that is how you are becoming eligible for Medicare, you can enroll into an Advantage plan three months before your month of eligibility until three months after you became eligible.
Annual election period — Also known as open enrollment or AEP, the annual election period for Medicare Advantage is October 15 through December 7 every year. Coverage for the Part C plan you choose during this time will begin January 1 the next year. During this time, you can also add, change, or drop current coverage.
Medicare Advantage Open Enrollment Period — During this open enrollment period, you are able to change from one Advantage plan to another or drop it to return to Original Medicare.
Special Election Period — There are several things that can trigger a special election period and they are unique to an individual. It is best to speak to a licensed Medicare insurance agent to find out if you qualify for a special election period. However, there are a few common instances we can talk about. Such as, if you move outside your Medicare Advantage plan’s service area, qualify for extra help (such as a program that helps pay for your prescription drugs), or move into a nursing home you might qualify for a special election period. During this time you can make changes to your Advantage plan or return back to Original Medicare.
Here you are able to contact us and we can help you to determine which enrollment period you are eligible for. Give us a call today!
We would love to chat with you about your Medicare coverage. Please send us an email or give us a call and one of our local agents will follow up with you soon!
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*Calling the number above will direct you to a licensed insurance agent. The purpose of this site is the solicitation of insurance products. Contact may be made by an insurance agent/producer or insurance company. Not affiliated with or endorsed by the government or federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.