A Private Fee-for-Service (PFFS) plan must cover all Medicare Part A and B benefits; it can also offer Medicare drug coverage (Part D).  

  • Premiums: A PFFS plan may charge a monthly premium in addition to the monthly Medicare Part B premium.  If the PFFS plan offers extra benefits that Medicare does not cover, such as routine vision or dental services, it may charge you a higher premium each month.
  • Deductibles and co-pays: PFFS plans charge both a yearly deductible and copays/coinsurances every time you see your doctor or other healthcare provider. Your costs will typically be lower if you see in-network providers. 

Before getting costly care from a doctor outside of the PFFS network, it is important that you or your provider ask for an advance organization determination before to make sure that the care is covered. 

If a doctor outside of the plan’s network treats you in an emergency, the doctor can charge you no more than what a network provider could have charged you for in-network care or $65, whichever is less.

  • Yearly Limit on out-of-pocket costs: All PFFS plans must have yearly limits on out-of-pocket Part A and B costs. The out-of-pocket limits can be high but may help protect you if you need a lot of health care or need expensive treatment. Out-of-pocket costs include deductibles, copays and coinsurances.