What is a Medicare Advantage Private-Fee-for-Service Plan?

A Medicare Advantage Private-Fee-For-Service Plan is an optional plan purchased from a private insurance company. Even with careful research this can be a risky venture since the provider has a free-hand with only two exceptions. Companies must provide all services covered under Original Medicare Parts A and B and adhere to Medicare Guidelines regarding determination of when/or if medically necessary services are needed.

How Medicare Advantage Private-Fee-For-Service Plan Works

Medicare pays a monthly amount to the provider but this does not cover premium cost. While there is no ‘services network’ requirement physicians must be qualified to receive payment and agree to accept the amount paid by the insurer.

Additional benefits may be offered such as vision and dental services however these may not be available in all areas of the country or may require residence within a certain network area to be eligible for these extra service offerings.

Are There Disadvantages to A Medicare Advantage Private-Fee-For-Service Plan?

One of the basic considerations when choosing a Medicare Advantage Private-Fee-For-Services plan is the higher premium and co-pay cost since companies are free set their own charges which are not governed by Medicare. If drug coverage is provided that coverage must be used exclusively. If coverage is not offered the patient must seek coverage from another company.

Most Medicare Advantage Private-Fee-For-Service Plans carry a restricted enrollment period of November 15th to December 31st or January 1st to March 31st. In the case of drug coverage, it one is not offered or appears to be insufficient to meet the needs of a particular situation, one may elect to switch to a different plan but must wait until the January 1st to March 31st period to apply for drug coverage.

Only you can decide if a Medicare Advantage Private-Fee-For-Service Plan is better than Original Medicare.

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