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
Network Areas for Non-employer PFFS Plans in Plan Year 2011 [zip, 64Kb] 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] PFFS Conference Follow-Up, 5/28/2008 [pdf, 112Kb]
Related Links Inside CMS
Private Fee-for-Service Application MA Payment Guide for Out of Network Payments, 10/01/08 Update [pdf, 138Kb] Beneficiary Guide to Private Fee-for-Service Plans [pdf, 207Kb] Health Plans General Information
Related Links Outside CMS
There are no Related Links Outside CMS

Page Last Modified: 03/05/2009 10:18:31 AM
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