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
Private Fee-For-Service Memo [pdf, 63kb] Model Private Fee-For-Service Terms and Conditions of Payment [zip, 82Kb] 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: 11/12/2008 11:31:46 AM
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