Carriers Dumping Medicare Advantage Private Fee-for-Service Plans

Health insurance carriers are dropping theirIn addition to the decreased government
Medicare Advantage Private Fee-for-Servicereimbursement amount for PFFS plans, PFFS plans
(PFFS) plans, according to recent announcementswill be required to develop healthcare provider
by some health insurance providers, includingnetworks beginning in 2011. The change will force
Coventry and WellCare. A PFFS is a MedicarePFFS plan holders to select their healthcare
Advantage (MA) plan that is available through aproviders from within the plan network, limiting
state licensed, risk-bearing entity, or a PFFStheir freedom to see providers that they prefer.
Medicare Advantage Organization (MAO).Experts predict that more healthcare insurance
As a result of PFFS coverage drops by Coventryproviders will follow Coventry and WellCare by
and WellCare alone, more than 500,000 Medicaredropping their PFFS plans in coming months.
plan holders will have to find new coverage.Individuals should contact their healthcare
At this point, Medicare Advantage plans receiveinsurance providers if they are currently enrolled in
government subsidies so that they can offera PFFS or are considering enrolling in a PFFS to
beneficiaries more benefits than simple Medicareget more information about how their provider will
plans. Medicare Advantage plans are offered torespond to the upcoming PFFS changes.
Medicare-eligible individuals by private healthMore Information About Medicare Advantage
insurers. However, analysts are expecting thePlans
reimbursement rates for these PFFS programs toMedicare Advantage plans are specific types of
fall by approximately 5%, making them lessMedicare plans that are in place to cover the cost
profitable for insurance carriers.of healthcare related expenses for Medicare
How PFFS Currently Workparticipants. These plans are similar to traditional
PFFS are popular amongst consumers becauseMedicare plans in that they provide financial
they allow Medicare beneficiaries to choose theirsupport for individuals seeking medical or
own healthcare providers, rather than having tohealth-related services. However, Medicare
select their providers from a limited number ofAdvantage plans generally have more benefits
in-network of Medicare-approved providers.and lower copayments than other types of
Beneficiaries can see any provider, as long as theMedicare plans. In order to have a Medicare
provider agrees to charge based on the PFFS feeAdvantage plan, Medicare participants need to
schedule. This fee schedule is the same as thehave Medicare Part A and Medicare Part B plans.
Medicare schedule.One major difference between Medicare
PFFS MAOs have yearly contracts with theAdvantage plans and other types of Medicare
Centers for Medicare and Medicaid Services toplans is that Medicare Advantage participants may
provide Medicare beneficiaries with their Medicareneed to see only doctors that are members of
benefits as well as additional benefits that athe Medicare Advantage provider plan. However,
company opts to provide. A PFFS provider paysplans may allow participants to use a wide variety
for healthcare instead of Medicare when aof services, including Medicare Health Maintenance
beneficiary has such a plan.Organizations, Preferred Provider Organizations,
The main benefit (which makes PFFS so popular)Private Fee-for-Service providers, and Medicare
is that individuals who join PFFS MAOs are notSpecial Needs providers.
required to use providers within a network andMedicare participants should be aware that
can, therefore, see any provider as long as theMedigap policies do not provide gap coverage for
provider is able to receive payment fromindividuals that participate in the Medicare
Medicare and the PFFS MAO.Advantage program.
More Changes to PFFS Plans