Aon Hewitt Navigators: PFFS Plans

Private Fee For Service (PFFS) plans, the number of these Medicare Advantage plans available in the marketplace is beginning to decline as a result of requirements to have provider networks. This is causing more Medicare recipients to migrate towards a PPO or HMO Medicare Advantage plan. Beginning in 2011, PFFS network requirements apply to approximately 80% of counties nationwide. The non-network PFFS plans are primarily in rural counties. The Medicare Advantage PFFS plans continue to be a viable low cost option with new requirements for provider networks. As part of your review and choice in selecting a PFFS plan, you will want to understand how using the provider network affects your out-of-pocket costs.

In 2011, most PFFS plans have provider network requirements, the non-network PFFS plans are offered in rural counties. You can receive care from any provider, if the provider is eligible to be paid by Medicare and agrees to accept the plans payment terms. If the PFFS plan has a provider network, you may have higher out-of-pocket costs if you see non-network providers. Some PFFS plans include Medicare Part D prescription drug coverage as part of the plan, while other plans provide care without this coverage. By law, PFFS plans, like all other Medicare Advantage (MA) plans, must be at least as good as Original Medicare.

Which doctors can I see with a PFFS plan?

The largest change for PFFS plans is the provider network requirement in most service areas. If the PFFS plan has a provider network you save more out-of-pocket costs when using network doctors, however, you may obtain healthcare services through any Medicare doctor or hospital in agreement with the terms and conditions of the plan. In an emergency, PFFS members can seek care from any Medicare physician. “Terms and conditions” describe the technical aspects of how physicians get paid for providing care.

I've read about some PFFS changes in the news. Can you tell me more?

The PFFS plans are encountering some of the greatest changes in how they are offered to Medicare recipients. This has resulted in private insurance companies to not renew their PFFS products which causes Medicare recipients to lose coverage and forces them to find another Medicare plan. The number of PFFS plans available in the marketplace has declined and Medicare recipients are beginning to migrate toward HMO and PPO Medicare Advantage plans. These plans continue to offer comprehensive benefit plans and are still a good option for Medicare beneficiaries. We at Aon Hewitt Navigators (formerly Senior Educators) are here to help you find the right plan and navigate these Medicare Changes.

How do I choose which plan is right for me?

Many people like help deciding which plan is a good choice for them. Plans vary widely from company to company and from place to place, and when comparing plans between companies it’s important to compare the fine print—not just the premiums. That’s what Aon Hewitt Navigators Insurance Services Inc. (formerly known as Senior Educators Insurance Services) was created for—to provide free, professional assistance to Medicare recipients to help them choose appropriate coverage. To request help now, please fill out the short informational form here so a licensed agent can be well informed about your healthcare preferences. Or simply give us a call to speak with a licensed agent now!

If you prefer to do the research by yourself, we’ve created a number of tools to help you do so. First, we have created our Top 10 Tips for Navigating Medicare, which captures a very high-level perspective on what to consider based on our years of experience. Second, we have created a plan comparison engine that shows you a list of the plans available in your area. To access that tool, enter your zip code on the side of this page and click the “Find Plans” button. We hope that if you find a plan through our tools, you’ll enroll through our organization, as this is what allows us to provide excellent, professional and impartial information and help.