PFFS plans provide nonemergency medical services through Medicare doctors and physicians. Unlike HMOs and PPOs, with PFFS plans there is no network of physicians. There are also no referrals before seeing a specialist. Some PFFS plans include Medicare Part D prescription drug coverage as part of the plan, while other plans provide care without this coverage. By law, PFFS plans, like all other Medicare Advantage (MA) plans, must be at least as good as Original Medicare.

PFFS plans provide nonemergency healthcare services through any Medicare doctor or hospital in agreement with the terms and conditions of the plan. In an emergency, PFFS members can seek care from any Medicare physician. “Terms and conditions” describe the technical aspects of how physicians get paid for providing care. For the vast majority of plans, physicians get paid the same amount as original Medicare and within 30 days for members in PFFS plans—so members don’t need to worry that their physicians will be paid less if they enroll in a PFFS plan.

PFFS plans have grown faster than any other type of Medicare Advantage plan in the history of the program. As mentioned above, these plans provide a high level of cost savings and a high level of choice. However, these plans are also newer than other MA plans, so many people in healthcare are not as familiar with the details as with other plans. The vast majority of clients who choose these plans are extremely happy with their PFFS plans, and we believe these plans will continue to grow faster than any other type of Medicare insurance for many years to come.

Many people like help deciding which plan is a good choice for them. Plans vary widely from company to company and from place to place, and when comparing plans between companies it’s important to compare the fine print—not just the premiums. That’s what Senior Educators Insurance Services was created for—to provide free, unbiased assistance to Medicare recipients to help them choose appropriate coverage. To request help now, please fill out the short informational form here so a licensed representative can be well informed about your healthcare preferences. Or simply give us a call at 1-800-236-4613 and speak with a trained and licensed representative now!

If you prefer to do the research by yourself, we’ve created a number of tools to help you do so. First, we have created the Senior Educators Insurance Services’ Top 10 Tips for Navigating Medicare, which captures a very high-level perspective on what to consider based on our years of experience. Second, we have created a plan comparison engine that shows you a list of the plans available in your area. To access that tool, enter your zip code on the side of this page and click the “Find Plans” button. We hope that if you find a plan through our tools, you’ll enroll through our organization, as it’s how we can afford to provide excellent, unbiased information and help.