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What Is a Private Fee-For-Service Plan?
Private Fee-For-Service (PFFS) is a type of Medicare Advantage plan offered by private
insurance companies under contract with Medicare. PFFS plans are not Medicare supplement, Medigap, or Medicare Select plans.
This means that the private-fee-for-service plan pays your claims instead of Medicare. You will pay the cost sharing listed
in the plan's summary of benefits. How Do Private Fee-For-Service Plans
Work?Under Private Fee-For-Service, you may go to any licensed doctor or
hospital in the U.S. that is willing to provide care and accepts the plan's terms and condition of payment. It is important
to note that every Provider has the right to decide whether or not to agree or to accept the plan's terms and conditions
each time they furnish a Covered Services to you. If your provider decides not to accept the plan's payment terms and
conditions of payment, you will need to find another provider that will. They should not provide services to you, except in
an emergency. Does a Private Fee-For-Service Plan Cover Everything That Original
Medicare Covers?Yes. By law, a Private Fee-For-Service plan must provide
enrollees with all of the benefits they would receive under Original Medicare. However, Advantra Freedom also provides benefits
such as 100% coverage for preventive care and $100 benefits annually towards eyewear and hearing aids. Can I Use the Same Doctors and Hospitals That I Use Now, or Do I Need to Use a Network of Physicians?Under Private Fee-For-Service, you can see any licensed provider who is willing to accept
the Medicare Private Fee-For-Service plan’s terms and conditions of payment. You are not locked into a network of providers
and you do not need a referral for covered services. What if my provider
won’t accept my Private Fee-For-Service plan?Providers are not required
to provide services to enrollees in a Medicare Private Fee-For-Service plan. If your provider currently bills Medicare, he
or she will receive the same reimbursement from Advantra Freedom as Original Medicare. If your providers do not want to accept
the plan’s terms and conditions of payment, you should seek care from another provider who is willing to provide services
to Private Fee-For-Service members. Do I Have to Go Through a Primary Care
Doctor like an HMO?No. Under Private Fee-For-Service, you can obtain care
directly from any licensed providers who are willing to accept the Medicare Private Fee-For-Service plan’s terms and
conditions of payment. Do I Need to Continue to Pay My Medicare Part B Premium
with Private Fee-For-Service?Yes. You must continue to pay your Medicare
Part B premium.
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