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Medicare PFFS

Medicare PFFS

A Medicare PFFS meaning is short for Private Fee for Service, which is one of the few Medicare Advantage plans available in certain areas. 

Understanding a Medicare PFFS

Understand that the Medicare PFFS plan does not work like a Medicare Supplement would, it is a Medicare Advantage plan. Before signing up for the plan know that the premiums, copays, coinsurance all incurred from medical services will be paid by you the signer. However, while that is similar to a PPO or HMO the difference is you are not limited to a network. 

This means that if you are to go to any medical care institution, you must show your Medicare PFFS plan card to the provider and they must agree to the terms and conditions of the plan, bill plan, and payment.  

Common Features

  • The PFFS card can be presented at any participating Medicare provider within the U.S. to see if the provider will then treat you. Those who travel a lot within the U.S. are likely to choose a Medicare PFFS plan because of this. 
  • PFFS plans can have a separate Part D drug plan meaning you are able to choose a drug plan with a different company while using the PFFS for covering health only.


The PFFS does not fill in for Medicare Supplement insurance and providers that decide not to contract with the PFFS plan do not have to treat you, unless the treatment needed is an emergency. Be sure you talk with healthcare providers ahead of time to see if they will agree to the bill plan and will treat you.