A Private Fee-for-Service (PFFS) Medicare Advantage plan differs from other MA plan types because it:

Why A is correct

A Private Fee-for-Service plan is a type of Medicare Advantage plan that sets its own payment amounts and terms and pays providers on a fee-for-service basis. A provider may treat the member if the provider agrees to accept the plan's terms and payment schedule for that service — even without a formal network contract. Members are not tied to a gatekeeper or referral process. PFFS plans must cover all Original Medicare benefits, and their network-less provider model is what distinguishes them from HMO, PPO, and SNP products under Part C.

Why the other options are wrong

• B) Requiring a single primary care physician gatekeeper describes an HMO-type MA plan, not a PFFS plan, so this option transplants the HMO model onto the wrong product.
• C) A PFFS plan is comprehensive medical coverage under Medicare Advantage, not a discount card, so this option mistakes a full plan for a limited discount product.
• D) PFFS members face normal Medicare cost-sharing and the plan's own terms; the payment schedule is set by the plan, and members do share costs, so this option is wrong on both points.

Memory hook

PFFS = the MA plan that lets providers decide case by case: accept the terms, treat the member, no network card needed.

Why D is correct

A PFFS plan is a type of Medicare Advantage plan that sets its own payment amounts for services. Members may receive care from any Medicare-eligible provider willing to accept the plan's terms; if a provider agrees to treat the member, it is paid according to the plan's fee schedule. PFFS plans do not necessarily require a gatekeeper or network, though some use networks to control costs. The any-provider-willing-to-accept-plan-terms feature distinguishes PFFS from HMO-style MA plans. The defining feature of a PFFS plan is that it sets its own payment amounts and terms for each service, and any Medicare-eligible provider who agrees to treat the member under those terms can be used. If the provider does not accept the plan's conditions, the member may be responsible for the full charge, which is why members should verify acceptance in advance.

Why the other options are wrong

• A) A gatekeeper and referral requirement describes an MA HMO, not a PFFS plan. PFFS plans generally require no gatekeeper or referral; members may see any provider willing to accept the plan's payment terms.
• B) A closed network of employed physicians describes a staff-model HMO, not PFFS. A closed network of employed physicians describes an HMO or staff-model plan, not the open-provider design of PFFS.
• C) PFFS plans are offered by private insurers approved by Medicare, not administered by the federal government. PFFS plans are offered by private insurers under contract with Medicare; they are privately administered, not federally run.

Memory hook

PFFS = find any Medicare doctor willing to take the plan's check.