How Healthcare Advantage Private Fee-for-Service (PFFS) Plans Work
A Private Fee-for-Service (PFFS) plan is a type of Healthcare Advantage plan that allows flexibility in provider selection without requiring referrals or primary care physicians (PCPs). These plans operate under annual contracts with the Centers for Medicare & Medicaid Services (CMS) to deliver standard healthcare benefits, along with optional additional benefits.
Key Features of PFFS Plans:
- Freedom to Choose Providers – Members can visit any licensed provider that agrees to the plan’s terms and conditions.
- No Referrals Needed – Enrollees can see specialists without prior authorization.
- Flexible Provider Payments – Healthcare providers are paid on a fee-for-service basis, with adjustments based on location, specialty, or preventive care incentives.
- Network or Non-Network Options – Some PFFS plans have provider networks, while others allow access to any provider accepting the plan’s terms.
PFFS plans are ideal for individuals who want flexibility in choosing healthcare providers without the constraints of HMO or PPO networks.
Eligibility for PFFS Plans
Private Fee-for-Service (PFFS) plans provide two options: one with prescription drug coverage and another without.
Unlike most Healthcare Advantage plans, which typically do not allow separate enrollment in a Part D prescription drug plan, PFFS plans offer greater flexibility. If you choose a PFFS plan without drug coverage, you can independently enroll in a Part D prescription drug plan that aligns with your specific medication requirements.
The eligibility criteria for a PFFS plan are consistent with other Healthcare Advantage plans. To qualify, you must be enrolled in both Healthcare Part A and Part B and reside within the plan’s designated service area, as per the 2025 healthcare guidelines.
Unlike most Healthcare Advantage plans, which typically do not allow separate enrollment in a Part D prescription drug plan, PFFS plans offer greater flexibility. If you choose a PFFS plan without drug coverage, you can independently enroll in a Part D prescription drug plan that aligns with your specific medication requirements.
The eligibility criteria for a PFFS plan are consistent with other Healthcare Advantage plans. To qualify, you must be enrolled in both Healthcare Part A and Part B and reside within the plan’s designated service area, as per the 2025 healthcare guidelines.
Ideal Candidate for a PFFS Plan
A strong candidate for a Private Fee-For-Service (PFFS) plan is someone looking for a flexible healthcare option with minimal restrictions. Unlike traditional network-based plans, PFFS plans allow beneficiaries to choose any healthcare provider, provided the provider accepts the plan’s terms and conditions.
These plans are especially beneficial for individuals who need prescription drug coverage but find that a standalone Part D drug plan offers better coverage for their specific medications. With the ability to customize prescription benefits, PFFS plans cater to those seeking both convenience and comprehensive healthcare solutions under the 2025 healthcare guidelines.
These plans are especially beneficial for individuals who need prescription drug coverage but find that a standalone Part D drug plan offers better coverage for their specific medications. With the ability to customize prescription benefits, PFFS plans cater to those seeking both convenience and comprehensive healthcare solutions under the 2025 healthcare guidelines.
Need Help Enrolling in a PFFS Plan?
Navigating Healthcare Advantage plans can be complex, as coverage details vary between providers. Understanding what’s essential versus optional can be challenging—that’s where our expertise comes in.
We’re here to simplify the process for you. Contact us by phone or fill out our online quote form today to explore available Healthcare Advantage plan options in your area. Our team will guide you through your choices, ensuring you find the plan that best fits your healthcare needs.
We’re here to simplify the process for you. Contact us by phone or fill out our online quote form today to explore available Healthcare Advantage plan options in your area. Our team will guide you through your choices, ensuring you find the plan that best fits your healthcare needs.
