If you live in Florida and are looking for a Medicare Advantage plan, you will have less choice when it comes to private fee-for-service (PFFS) Plans with each passing year.
Florida is not the only State experiencing non-renewals, whether you are in neighboring Alabama or on the West Coast, you will find less choice when it comes Medicare Advantage PFFS Plans.
Starting in 2011 Medicare Advantage carriers had to begin to offering a network- based plan in service areas where they offer private Fee-for-service plans. Some rural areas will not support a network large enough to be credible.
Some Medicare Advantage Plan carriers are cutting their losses and pulling out.
Medicare Advantage PFFS
Some have asked if the cut backs in PFFS plans are not really a good thing. After all these plans do have their drawbacks. On the surface PFFS plans offer a great amount of freedom but obtaining covered services can often be unpredictable.
You are not required to use a network and can choose your own providers but the plan decides how much they will pay doctors and hospitals and how much you will pay for services.
You can go to any Medicare approved doctor or hospital if they agree to treat you. Not all providers will accept the plan’s payment terms or agree to treat you. In fact, they can decide to treat you on a visit by visit basis except in the case of an emergency. Not exactly user friendly!
Do your homework
If you have a Medicare Advantage PFFS plan that is not renewing now is the time to do your homework. You can go to the Medicare website and search plans to find what is available in your area. You may find that you have a HMO or PPO plan in your service area that will suit your needs.
When an insurance company contracts with CMS to offer a Medicare Advantage plan, it is for one contract year at a time. In addition the contract is on a County by County basis. Each year insurance companies can assess the profitability of renewing their Medicare Advantage contract in each of the Counties that they offer plans.