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What is a Medicare Advantage Private Fee for Service (PFFS) plan?

A Medicare Advantage Private Fee for Service (PFFS) plan is a Medicare health plan sponsored by private insurance companies, such as United Healthcare, Coventry, Wellcare and many others. These plans are popular because they are not tied to a specific doctor or hospital network. You are allowed to visit any doctor or hospital as long as the doctor or hospital is willing to accept payment from this insurance company.

What is happening to these plans?

Many insurance companies that offer PFFS plans have decided to cancel their Medicare PFFS insurance coverage for the 2010 year. This means that an estimated 660,000 Medicare beneficiaries that are currently enrolled in Medicare PFFS plans will need to change their plan by enrolling in a new Medicare plan during the open enrollment period.

How will I know if my plan is canceled?

If you are enrolled in a Medicare PFFS plan that has been canceled for 2010, you will receive information in the mail from your Medicare insurance carrier. This information will include instructions regarding your options.

What are my options if my plan is canceled?

You are not required to stay with the same insurance company if your PFFS plan was canceled. You may select a plan offered by the same insurance company or pick a new plan from a different insurance company in your area.

Which plan provides the most similar benefits to my Private Fee for Service Plan?

Generally, Original Medicare or a Medicare Advantage PPO plan provides the most similar benefits to a Medicare Advantage PFFS plan. If you choose the Original Medicare plan, you will also need to sign up separately for a Medicare Prescription Drug plan. You may also want to sign up for a Medicare Supplemental plan (Medigap) to help pay some of the costs from the Original Medicare plan.

If you choose a Medicare Advantage PPO plan, you probably will not have to sign up for a separate Prescription Drug plan, as most Medicare PPO plans include prescription drug coverage.

What is the best plan for me?

The plan that best meets your needs varies from person to person, depending on your health situation.  Use the Medicare Plan Enrollment Form to enter your health information and compare the plans in your area in order to find the plan that best meets your personal needs.

When will my PFFS plan end?

If your company has notified you that they are canceling your Medicare Advantage PFFS, your insurance will end on 12/31/2009.

When do I have to enroll in a new plan?

The deadline for enrolling in a new plan is 1/31/2010. If your Medicare plan is canceled, you can enroll beginning two months before the plan ends and up to one month after the plan terminates. If you don’t enroll by 12/31/2009, you will be automatically enrolled in Original Medicare on 1/1/2010. However, you are still eligible to switch to a Medicare Advantage HMO or PPO plan until 1/31/2010.