PFFS Plans vs Medicare: Differences between PFFS Plans and Original Medicare

Original Medicare plans are public fee for service programs. While Private-Fee-For-Service plans (PFFS) seem like an exciting alternative to Original Medicare, they also come with a greater price tag. For someone on a fixed budget, PFFS plans might not be a financially feasible route.

Premiums For PFFS Plans

While both Original Medicare and PFFS plans charge a monthly premium for Part B insurance (outpatient), PFFS plans charge an additional monthly premium on top of Part B insurance. Doctors and hospitals under PFFS have no capped limits which can mean more financial expenses for the patient.

Benefits of Original Medicare and PFFS Plans

Under Original Medicare, a patient does not receive Part D insurance (drug prescription coverage) as part of the insurance plan, only Parts A (hospital) and B (outpatient) insurance are provided. However, this is no the case with some PFFS plans. Some PFFS plans also includes Part D coverage while others do not. To receive prescription drug coverage will add on an additional monthly cost to the PFFS insurance premium.

Providers of Original Medicare and PFFS Plans

Under Original Medicare, there is no limit to the number of doctors or hospitals a patient can receive services from. Most doctors and hospitals accept Medicare automatically; however, with PFFS plans, the situation becomes more complex. Some PFFS plans come with a network of doctors, but most do not. If a patient has a PFFS plan that does not come with a network of providers, he or she must find out whether or not a certain doctor or hospital is willing to accept the PFFS plan. If the PFFS plan does come with a specific network of doctors, then a patient may pay more for their PFFS plan should he or she decide to go outside the prescribed network.

Cost Sharing in Original Medicare and PFFS Plans

With Original Medicare, a patient can go to the hospital for medical help and outside of the 20% coinsurance and copayment they can expect to pay only a little extra. With PFFS plans, however, even a simple visit to the hospital can cost more---particularly if a patient visits a doctor outside of a prescribed network of doctors. Most PFFS plans do not have a prescribed network, so a patient will most likely pay more when he or she visits a doctor or hospital.

Supplemental Coverage in Original Medicare and PFFS Plans

Patients often want to know whether or not they can add a Medigap policy to their insurance plan if their plan does not meet all of their medical expenses. Under Original Medicare, a person can add a Medigap policy; however, this is not the case for PFFS plans. Moreover, buying a Medigap policy while under a PFFS plan is illegal and subject to federal repercussions as prescribed by law.

When comparing the costs of Original Medicare and PFFS plans, one must weigh the pros and cons and decide based on the plans available which is the right plan for them. If a patient wants more benefits, he or she will have to pay more. If a patient cannot afford a PFFS plan or Original Medicare with a Medigap policy, he or she will simply have to content themselves with the services provides through Original Medicare.

Auntie Lou says, "Its important to look into getting Extra Help if you can't meet your Medicare costs."