Medicares Private Fee-for-Service Plans Not Well
Known to Many Seniors; Mixed Reviews
PFFS plans are the fastest-growing Medicare Advantage
plans on the market
May
27, 2008 Medicare used to be nice and simple, but it offered less.
Now, there are many options about how to obtain your medical insurance
through Medicare but many are still not well understood. In the analysis
below, ElderLawAnswers.com looks at the private fee-for-service plans.
Some advocacy groups think original Medicare is better.
Private fee-for-service (PFFS) plans are a way to
give private insurance companies access to the vast Medicare market and
are part of an effort to further privatize Medicare. PFFS plans are the
fastest-growing Medicare Advantage plans on the market. While the
additional benefits these plans often offer may look attractive,
Medicare beneficiaries should look carefully before they leap into one.
Enables CMS to use Medicare Part D claims data for
research, program oversight and evaluation, care coordination, quality
improvement, and performance measurement initiatives
In a PFFS, Medicare pays a set amount each month to
a private insurer to provide health coverage on a fee-for-service basis
to Medicare beneficiaries. Unlike a health maintenance organization
(HMO) or preferred provider organization (PPO), PFFS members can choose
from any Medicare-approved provider as long as the provider is willing
to accept the plan's payment terms.
PFFS plans differ from original Medicare in that
there is no limit to the premiums or co-payments a PFFS can charge. PFFS
plans may offer additional benefits, such as vision or dental, but
members may have to share some of the costs with Medicare.
PFFS plans may let providers charge up to 15
percent above the plan's payment amount for services.
Although the additional benefits offered through a
PFFS plan may seem advantageous, a
report by the Medicare Rights Center finds that private Medicare
plans actually offer many disadvantages compared to original Medicare.
For example, care can be more expensive because
co-payments may be higher. In addition, it may be more difficult to find
a doctor who will accept the plan's payment terms. PFFS plans have also
come under scrutiny for their aggressive marketing practices. Sales
agents have been accused of fraud for signing up seniors who were not
aware how PFFS plans differed from original Medicare. For more
information,
click here.
Before you enroll in a PFFS plan, look closely at
the monthly premium, co-payments, and the cost of extra benefits to make
sure that this is a plan you can afford. You can call 1-800-MEDICARE or
go to
www.medicare.gov to compare plans.
Prescription drug coverage Some PFFS plans offer prescription drug coverage. If the plan you
choose has drug coverage, you must use the coverage offered by that
plan. You may not enroll in a separate drug plan. If your PFFS plan does
not offer prescription drug coverage, you can either switch to another
plan that has drug coverage or add this coverage separately.
Switching plans You can only switch to a different PFFS plans or back to original
Medicare at certain times of the year. You can switch during the
election period from November 15 - December 31 or during the open
enrollment period from January 1 - March 31 of each year. Note that if
you are switching from a PFFS plan with drug coverage to one without,
the only time you can add drug coverage is during the election period
from November 15 through December 31.
>> For more information from Medicare on how
PFFS plans work,
click here.
