A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan, offered by a state licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services to provide beneficiaries with all their Medicare benefits plus any additional benefits the company decides to provide.   One major difference between a PFFS Medicare Advantage Organization (MAO) and other MAOs is that, in most cases, people who join a PFFS MAO are not required to use a network of providers.  Beneficiaries can see any provider who is eligible to receive payment from Medicare and agrees to accept payment from the PFFS MAO. 

On January 19, 2010, CMS released guidance titled "Transition of Private Fee-for-Service Contractors to Network-Based Access Requirements" that updated the list of network areas for non-employer PFFS plans for contract year 2011. The updated list of network areas for contract year 2011, along with the list of 601 counties that were removed from the list that was previously released with the 2010 Advance Notice and 2010 Announcement can be downloaded from below.

Downloads
Network Areas for Non-employer PFFS Plans in Plan Year 2011 [zip, 133Kb] Model Private Fee-For-Service Terms and Conditions of Payment [zip, 167Kb] Provider Contacts for Terms and Conditions of Payment [zip, 16KB] Ensuring Beneficiary Understanding of PFFS Plans, Actions and Best Practices [zip, 192 KB] PFFS Conference Follow-Up, 5/28/2008 [pdf, 112Kb]
Related Links Inside CMS
Private Fee-for-Service Application MA Payment Guide for Out of Network Payments, 10/01/08 Update [pdf, 138Kb] Beneficiary Guide to Private Fee-for-Service Plans [pdf, 207Kb] Health Plans General Information
Related Links Outside CMS
There are no Related Links Outside CMS

Page Last Modified: 01/21/2010 3:30:04 PM
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