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What is medicare pffs

what is medicare pffs

PFFS versus PPO: What's the difference when it comes to Medicare Advantage?

Posted by Alex Tolbert on Mon, Sep 06, 2010 @ 17:09

With the recent announcement that Blue Cross is terminating its Private Fee for Service (PFFS) plans in Tennessee, many are asking: what's the difference between the PFFS plans and the PPO plans?

Medicare questions are normal, and this is a recently big area of concern.

Well, first of all, let's get specific about what we're talking about. We are just talking about Medicare Advantage plans. These are plans that often have a low premium, and the government pays private carriers to take on the risk of each Medicare beneficiary who the carrier signs up.

With PFFS plans, the beneficiary does not have a guarantee that a doctor is "in-network" because there really isn't a network. These plans were initially allowed by CMS (the government), which allowed insurance companies to offer

the plans without necessarily constructing a network of providers.

With PPO plans, there is a network of contracted providers, which gives the beneficiary more of a guarantee that he/she can know which doctors are in-network.

Now that Medicare Advantage plans have grown to be one of the largest of the Medicare insurance options, CMS is putting restrictions on the numbers of PFFS plans out there. For that reason, Blue Cross Blue Sheild of Tennessee is about to send 19,000 letters to members who have PFFS plans with the insurance company. The letters will say that the PFFS plans are terminating, and the beneficiaries need to make a new selection.

Maybe a Blue Cross Blue Shield PPO plan will be best. Or maybe a plan from Healthspring. Perhaps Humana will present the best option. At the Bernard store on Thompson lane here in Nashville, our MediGuidance product can help you find the right choice for you!

Category: Insurance

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