Texas Medicare PFFS

Medicare Private fee-for-service (PFFS) plans are Medicare Advantage plans offered by private insurance companies.

A Medicare Advantage Private-Fee-for-Service plan works differently than a Medicare Supplement plan. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you. If your doctor or hospital does not agree to accept the plan’s payment terms and conditions, you should seek care from another provider.

For this reason, you should call your important doctors and hospitals prior to enrolling in a Medicare PFFS plan, to make sure they are willing to accept your insurance. You will need to re-confirm this prior to each appointment with a healthcare provider.


Medicare PFFS plans are now offered in only a small number of select counties in the U.S. The plans offered vary by county. Some plans also include the Part D prescription drug card, while others do not. You can join or leave the plan only at certain times. The plan’s benefits, formulary, pharmacy network, premium and/or copayments and coinsurance may change on January 1 of each year.

For these reasons, it’s to your advantage to work with an experienced indepent insurance agent who specializes in Medicare-related insurance plans and can point out the plan’s rules to you and be sure you thoroughly understand them.

To learn if a Medicare PFFS insurance plan is available in your county, phone our office or request online help:
Texas Medicare PFFS Quotes