Private Fee-for-Service (PFFS)

Medicare Advantage Private Fee-for-Service (PFFS) plans feature an element of predictability not seen with other insurance plans. With Medicare PFFS, you will know your exact costs.

What Do PFFS Plans Cover?

Medicare Advantage PFFS plans offer comprehensive inpatient and outpatient coverage. Some PFFS plans include drug coverage. The medications covered depend on the exact plan you enroll in, as coverage varies from plan to plan. Your insurer will try to get you the generic version of your medication whenever possible, so that your expenses will be kept to a minimum. If your plan doesn’t offer drug coverage, you can find a separate Part D plan to fill in that gap in coverage.

Dental, vision, and hearing services can also be included, which is another reason why PFFS plans hold an advantage over traditional Medicare plans.

Get all of your options

What Makes PFFS Plans Different?

The primary feature of PFFS plans is their approach to cost-sharing. Unlike other plans, you’ll know your exact costs ahead of time. You won’t have any fluctuations in coverage. However, costs may change from year to year, but that is common for every insurance plan.


PFFS plans vary when it comes to coverage networks. Some plans allow you to go to any doctor or healthcare facility in the US that accepts Medicare. Other plans have contracts with specific providers in a network. Plans vary, but in any case, emergencies will be covered no matter which part of the US they occur.


Plans may have an agreement with in-network providers requiring them to treat you no matter what, regardless of whether they’ve seen you in the past. And if your plan has a network, you may have to cover all costs for non-emergency treatments out-of-network.


You don’t have to choose a primary care physician, and you won’t need referrals to see specialists. But before you see any physicians, make sure they accept your plan. This way, there will be no billing complications when you get treatments.

Find a PFFS Plan Today

Covenant Medicare is here to bring you the Medicare coverage you need when you need it the most. Give us a call today to learn more about Medicare Advantage and PFFS plans!

Talk with us about your medical needs