Special coverage: Medicare

Picking over private fee for service plans

Consider the total cost before signing up for one of these, and make sure your doctor will work with a PFFS company.

By STEPHEN NOHLGREN, Times Staff Writer
Published November 27, 2007

For years, people on Medicare had two choices on how they wanted to receive treatment:

• Traditional Medicare allowed them to pick their doctors and hospitals and seek service whenever they wanted.
• Private Medicare HMOs would administer their care. HMOs usually cost less, but patients had to use doctors, hospitals and other providers from within the HMO's network. Sometimes, patients couldn't see a specialist without a referral. The HMO was a basic trade-off between price and benefits that was fairly easy to understand.

These days, people on Medicare face several new options, none more confusing than an arrangement called Private Fee For Service, or PFFS. On the surface, these plans sound like traditional Medicare, but with more bells and whistles and less cost.

Some PFFS plans offer to reduce your Part B premium, give you low-cost drugs or make your Medicare copayments, all the while letting you choose your doctor.

What's not to like?

But rapid enrollment growth, poor administration and aggressive marketing have cast a shadow over the fee-for-service market.

The fact is, many doctors refused to deal with the PFFS companies. People who signed up for plans, thinking they were getting a break, found that their doctors of many years wouldn't treat them.

People went to luncheons thinking they were just gathering information, only to find that an insurance agent had signed them up for a PFFS without their knowledge.

Midway through 2007, Medicare made the largest companies halt their marketing because too many people were confused at best, and duped at worst.

Supposedly, new safeguards are in place this year to make sure that people on Medicare know what they are getting into. If an agent signs you up for a fee-for-service plan, a representative of the insurance company is supposed to call you and review the coverage, making it clear that some doctors may not accept these payments, and that doctors can decide to stop accepting payments at any time.

As a general rule, talk to your doctor first before signing anything, or giving your Social Security number to an insurance agent. Find out which plans your doctor accepts and which he or she does not.

[Last modified December 5, 2007, 20:22:50]