Medicare PFFS Eligibility

You can qualify for Private-Fee-For-Service plans (PFFS), as long as you live in an area where the plan exists, own Medicare Parts A (hospital) and B (outpatient), and do not have kidney malfunction at the time you apply for membership. Other preexisting conditions will not affect your eligibility.

How Geographic Location Affects PFFS Eligibility

PFFS plans are tied to geographic location. In certain places of the United States PFFS plans are offered while they are not in others. A person in Minnetonka, Minnesota cannot take advantage of an AARP MedicareComplete Plus Plan, while a resident of Richmond, Virginia can. In the state of Indiana, for example, Medicare Advantage PFFS plans are offered, but they are not offered in every county of Indiana. Anthem's Smart Value PFFS plan is only extended to those living in the following states: Colorado, Connecticut, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Virginia, and Wisconsin. Even in those states, only certain counties (five counties in Connecticut alone) qualify for Anthem's PFFS plan. Depending on where you live, certain PFFS plans will be accessible to you while others will not. Geographic factors also play a vital role in how much your monthly insurance premiums will cost.

How Medicare Parts A and B Insurance Affect PFFS Eligibility

Another factor in determining PFFS eligibility involves the ownership of both Parts A (hospital, inpatient) and B (outpatient) insurance. Private-Fee-For-Service plans (PFFS) are also known as "Medicare Advantage" plans (Part C insurance), and require Parts A and B in order to buy a PFFS plan. PFFS plans are renewable each year; should your PFFS plan not be renewed, you will have to decide to either 1) stay with Original Medicare or 2) find a new PFFS plan.

The Impact of Kidney Dysfunction and Malfunction on PFFS Eligibility

The last factor in considering PFFS plan eligibility involves kidney dysfunction and malfunction. If you have kidneys that are not functioning, need dialysis, or a kidney transplant, you do not qualify for PFFS plans.

Other PFFS Eligibility Factors

Alongside the factors discussed above, you can also qualify for PFFS plans if you do not have any other way of financing your medical expenses prior to the deductible. PFFS plans are a type of Medicare Plan (though an alternative one) that are provided to people that have overwhelming medical expenses and financial need.

Geographic location, ownership of previous Medicare insurance, and the presence or absence of kidney failure can affect your eligibility for PFFS insurance plans. These are important factors to consider when purchasing insurance.