You may have noticed that the amount of Medicare Advantage PFFS plans in your area have been slowly disappearing! PFFS stands for Private Fee For Service, and it was designed to give Medicare Advantage beneficiaries the ability to go to a large number of doctors without the constraint of a network. Since no network existed there was no provider directory for beneficiaries to be able to look up their doctor. Instead, they would have to call the doctor and asked if he/she would accept the insurance. Also, the doctor could decide on a per visit basis whether or not to accept it.
Most Medicare Advantage PFFS Plans Must Have a Network
A new MIPPA law in 2008 required PFFS plans to start having a network in most counties starting in 2011. The few counties that were excluded were typically rural counties. This forced the PFFS plans to either drop their plan or go out and create a network. The result was the PFFS plans being dropped for the most part. You will be able to find some PFFS plans still in 2011, and there will be some in 2012 as well. As stated before though, they are few and far between now. Some Medicare beneficiaries will see this as an improvement since they will be able to use a directory to look up a doctor.
Medicare Advantage Beneficiaries Now Have Less Options
The reality is that with less plans comes less options. Not only that, but a great option for some beneficiaries has been lost. The reason is that since the Medicare Advantage PFFS plans did not require a network before, beneficiaries that wanted a Medicare Advantage plan without the restrictions of a network were able to find that with the PFFS plans.
Medicare Advantage PFFS Enrollees Must Check Your Network
If you are enrolled in a Medicare Advantage PFFS plan that is now carrying a network, make sure you check your directory for the upcoming year. Your doctor or hospital of choice may have been dropped from the directory for the upcoming year! If so, you will want to compare the other Medicare Advantage plans in your area. When comparing the other plans you will likely find HMOs or PPOs as your alternative. You can compare plans at www.medicare.gov