Plans
PFFS
Quick answer
A Private Fee-for-Service (PFFS) plan is a type of Medicare Advantage plan that sets its own payment rates. You can see any Medicare-eligible provider who agrees to the plan's terms on a per-visit basis.
Plain-English definition
PFFS plans may or may not have a formal network. Providers can decide visit-by-visit whether to accept the plan.
Why it matters
PFFS offers flexibility but requires confirming provider acceptance before every visit.
A simple example
Your PFFS plan doesn't have a network — you show your ID card and the provider decides whether to accept the terms.
Common mistakes & misconceptions
Related terms
HMO
A Medicare Advantage HMO is a plan that uses a specific network of doctors and hospitals. You choose a primary care provider (PCP) and usually need a referral to see specialists.
PPO
A Medicare Advantage PPO lets you see providers in or out of the network, usually without a referral. Out-of-network care costs more and has its own MOOP.
Medicare Advantage (Part C)
Medicare Advantage, also called Part C, is a way to receive your Medicare benefits through a private insurance plan approved by Medicare. Plans bundle Part A and Part B, usually include Part D drug coverage, and often add dental, vision, and hearing.
Frequently asked questions
Is PFFS common?+
Less common than HMO or PPO.
Sources & references
📚 Where this information comes from
- Medicare.gov — official U.S. government site for people with Medicare ↗Primary source for benefits, enrollment periods, and plan comparison.
- CMS.gov — Centers for Medicare & Medicaid Services ↗Federal rulemaking, program updates, and official guidance.
- Social Security Administration — Medicare enrollment & premiums ↗Enrollment, premium withholding, and IRMAA determinations.
When you're ready, compare plans on your own terms
See Medicare Advantage plans from the insurance companies we represent, or walk the course with a licensed agent whenever you'd like a second set of eyes.
We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.
Medicare Caddies is an independent insurance agency. We are not affiliated with, endorsed by, or connected to the U.S. government, the federal Medicare program, or the Centers for Medicare & Medicaid Services (CMS). We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.