What must PFFS members do to receive coverage under the plan?

Choosing Medicare-eligible providers who agree to the plan's terms is crucial for PFFS (Private Fee-For-Service) members to receive coverage. PFFS plans allow beneficiaries to have the flexibility to see any Medicare-approved provider; however, these providers must also agree to accept the plan’s payment terms. This means that even though PFFS members have extensive options, it hinges on the agreement of the provider to accept the specific conditions laid out by the PFFS plan.

Utilizing Medicare-eligible providers ensures that care is provided in adherence with Medicare guidelines, which is essential for coverage under the PFFS structure. When providers agree to the plan, they also assume responsibility for the services rendered, making it a lawful arrangement that aligns with Medicare regulations.