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Question: 1 / 360

What does a Medicare Private Fee-for-Service Plan entail?

Providers are chosen from a national network

Medicare pays a set amount to a private insurer to cover care

A Medicare Private Fee-for-Service (PFFS) Plan involves Medicare paying a set amount to a private insurer to cover care. This type of plan allows beneficiaries more flexibility compared to traditional Medicare by enabling them to visit any Medicare-approved provider who agrees to accept the plan's payment terms. In PFFS plans, there isn't a designated network of providers, which differentiates them from other plan types like Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs).

The payment structure plays a significant role in how care is accessed. Private insurers operating these plans have the freedom to establish their rates, but they must comply with Medicare's stipulations. This financial arrangement encourages a broader range of healthcare options for individuals, like specialists and various treatment facilities, without needing referrals, which aligns with the characteristics of a PFFS plan.

Other options, such as having providers chosen from a national network, covering only emergency services, or being classified as an HMO plan that requires referrals, do not accurately depict the operational structure of a PFFS plan. Those options reflect different types of Medicare or health plans that have more restrictions and structured networks.

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It only covers emergency services

It is an HMO plan that requires referrals

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