A PFFS plan is a private fee-for-service Medicare Advantage plan, and it is the category with the strangest rule in the programme: in the classic form, there is no network, and whether a provider treats you is decided by that provider each time, based on whether they accept the plan's terms of payment.
The rule that makes it different
Instead of contracting a network in advance, a private fee-for-service plan publishes terms and conditions of payment, and a provider may choose to accept them for a given episode of care. That means a doctor who treated somebody last year is not obliged to this year, and the obligation is checked at the point of care rather than settled in advance. It is the opposite arrangement to an HMO, where the network is fixed and the referral is the control.
Why the category shrank
Rules introduced over the past two decades pushed most of these plans toward contracted networks in areas where network plans are available, which removed much of what distinguished the category in the first place. The result is that private fee-for-service is now a small part of the programme. That history matters to a reader mainly because a lot of what is written about these plans online describes the older form, and the current rules are on Medicare's own pages.
What this site can and cannot add
This index does not break Medicare Advantage down by plan type, so it cannot say how many people in a state hold this particular category. What it carries is the total: how many people in each state are in a Medicare Advantage or other health plan at all, against how many stayed in Original Medicare, from CMS's own file with the date it was read. That total is the denominator any category sits inside.
Questions people ask about pffs plan
Is a PFFS plan the same as Original Medicare?
No. It is a Medicare Advantage plan, so the private plan is the payer, not Medicare. The similarity people notice is the absence of a fixed network in the classic form.
Can my doctor refuse to treat me under one?
In the classic form a provider decides whether to accept the plan's terms, and that decision can be made each time. Medicare's own pages set out how the current rules work.
Are there many of these plans left?
Far fewer than there once were. Rule changes pushed most of the category toward contracted networks.
Does this site say how many people hold one?
No. The enrollment file it uses counts Medicare Advantage as a whole rather than by plan type.