A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan, offered by a state licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services to provide beneficiaries with all their Medicare benefits plus any additional benefits the company decides to provide.   One major difference between a PFFS Medicare Advantage Organization (MAO) and other MAOs is that, in most cases, people who join a PFFS MAO are not required to use a network of providers.  Beneficiaries can see any provider who is eligible to receive payment from Medicare and agrees to accept payment from the PFFS MAO. 

Downloads
Provider Contacts for Terms and Conditions of Payment [zip, 16KB] Ensuring Beneficiary Understanding of PFFS Plans, Actions and Best Practices [zip, 192 KB]
Related Links Inside CMS
September 24, 2007 CMS Press Release - Seven Medicare PFFS Plans Are Approved Following Rigorous Marketing Review Private Fee-for-Service Application MA Payment Guide for Out of Network Payments, 2/06/08 Update June 15, 2007 CMS Press Release "Plans Suspend PFFS Marketing" Beneficiary Guide to Private Fee-for-Service Plans
Related Links Outside CMS
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Page Last Modified: 04/04/2008 10:19:32 AM
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