There are several different types of Medicare Advantage Plans.  Many of these plans are offered at no additional charge to the Medicare recipient. What is discussed below is Private Fee-For-Service.  Many people on Medicare in rural areas have found this to be a good option.  Medicare HMO's are another option available to people on Medicare, but please call for details that are specific to your area of the state. 

What Is a Private Fee-For-Service Plan?

Private Fee-For-Service (PFFS) is a type of Medicare Advantage plan offered by private insurance companies under contract with Medicare. PFFS plans are not Medicare supplement, Medigap, or Medicare Select plans. This means that the private-fee-for-service plan pays your claims instead of Medicare. You will pay the cost sharing listed in the plan's summary of benefits.

How Do Private Fee-For-Service Plans Work?

Under Private Fee-For-Service, you may go to any licensed doctor or hospital in the U.S. that is willing to provide care and accepts the plan's terms and condition of payment. It is important to note that every Provider has the right to decide whether or not to agree or to accept the plan's terms and conditions each time they furnish a Covered Services to you. If your provider decides not to accept the plan's payment terms and conditions of payment, you will need to find another provider that will. They should not provide services to you, except in an emergency.

Does a Private Fee-For-Service Plan Cover Everything That Original Medicare Covers?

Yes. By law, a Private Fee-For-Service plan must provide enrollees with all of the benefits they would receive under Original Medicare. However, Advantra Freedom also provides benefits such as 100% coverage for preventive care and $100 benefits annually towards eyewear and hearing aids.

Can I Use the Same Doctors and Hospitals That I Use Now, or Do I Need to Use a Network of Physicians?

Under Private Fee-For-Service, you can see any licensed provider who is willing to accept the Medicare Private Fee-For-Service plan’s terms and conditions of payment. You are not locked into a network of providers and you do not need a referral for covered services.

What if my provider won’t accept my Private Fee-For-Service plan?

Providers are not required to provide services to enrollees in a Medicare Private Fee-For-Service plan. If your provider currently bills Medicare, he or she will receive the same reimbursement from Advantra Freedom as Original Medicare. If your providers do not want to accept the plan’s terms and conditions of payment, you should seek care from another provider who is willing to provide services to Private Fee-For-Service members.

Do I Have to Go Through a Primary Care Doctor like an HMO?

No. Under Private Fee-For-Service, you can obtain care directly from any licensed providers who are willing to accept the Medicare Private Fee-For-Service plan’s terms and conditions of payment.

Do I Need to Continue to Pay My Medicare Part B Premium with Private Fee-For-Service?

Yes. You must continue to pay your Medicare Part B premium once you enroll in Advantra Freedom.