Texas Medicare PFFS plans are not as common as they used to be. If you live in a rural service area where there are not many HMO or PPO options to choose from, you may find a Medicare PFFS plan available. The plan may have a small network, but PFFS plans have a special feature.
Medicare PFFS Doctor Deeming
You can use your coverage at any provider that accepts the plan’s payment terms and conditions. Notify the provider ahead of time about your coverage. The provider can contact the plan to see what his or her reimbursement will be. If the provider agrees to accept the plan, then you can use your Medicare PFFS plan at that provider’s office. This is called “deeming.” The doctor is deemed to be covered because he agreed to the payment terms.
Some PFFS plans have Part D integrated, and some do not. If you enroll in one without Part D, you can choose to enroll in a standalone Part D plan to go alongside it. In fact, PFFS plans are the only type of Medicare Advantage plans that allow a separate drug plan.
These plans are very popular with snowbirds and other Medicare beneficiaries who travel since you can use them nationwide. Premiums for Medicare Advantage plans are lower than premiums for Medigap plans. This gives travelers an option to have coverage that will work for them anywhere a provider agrees to accept it.