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Private Fee for Service Plans with No Part D Prescription Drug Benefit

Private Fee for Service is a Medicare Advantage Plan where a Private Insurance company provides your Medicare Part A and Part B benefits. In a Private Fee for Service Plan, you can get Medical Services from any provider who accepts the terms and conditions of the plan. Private Fee for Service works differently than Original Medicare and Medigap insurance. Premiums will vary depending on the plans available in your area. Depending on the plans available in your area, some of the plans may include Dental, Vision, Hearing, Gym Memberships. Additionally, some plans may include a Maximum out of Pocket which would put a cap on your financial exposure in a calendar year. This option would include no Medicare Prescription Drug benefit.

Disclaimer:

A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to agree to accept the plan's terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept payment terms and conditions, or otherwise agree to treat you, you will not be able to receive covered services from them under this plan.

Is this option right for me?

If you have other supplementary coverage for Prescription Drug coverage (for example, VA Drug benefits), this could be a good choice.
If you are willing to get your Medical Services from providers who are willing to accept this plans terms and conditions, this could be a good choice.
If you are willing to accept higher out of pocket costs when you receive medical services in exchange for lower monthly premiums, this could be a good choice.
If you would like to receive "Value Added" benefits like hearing, dental, vision and/or gym membership, this could be a good choice.
If you'd like a cap on your maximum out of pocket expense, this could be a good choice.

Advantages

Financial Exposure to Part A and Part B cost sharing can be capped depending on the specifics of the plans in your area.
Premium can be lower than a Medicare Supplement depending on the specifics of the plans in your area.
Additional Value Added benefits may be available (like Dental, Vision, Hearing and Gym benefits) depending on the specifics of the plans in your area.
No Part D plan means you will not pay a Part D premium.

Disadvantages

Out of Pocket costs depending on your level of utilization of services in the Private Fee for Service Plan subject to the maximum out of pocket.
Must use providers who are willing to accept the terms and conditions of the plan.
Depending on your county of residence, Private Fee for Service plans may require a Network of Hospitals and Physicians.
Medicare Advantage plans are not Guaranteed Renewable like Medicare Supplement plans. In addition, the benefits can be changed on a calendar year basis.
Unlimited financial exposure for Part D Prescription drug expenses.
Late Enrollment Penalty would apply for Medicare Prescription Drug benefit unless there is other Creditable coverage.

Costs — Medical and Hospital

Premium for the Private Fee for Service plan will vary based on the county of your residence and the plan you choose to enroll in.
Generally, there is cost sharing for Hospitalization, Doctor Office visits, diagnostic tests, x-ray, therapy, etc. You will need to review the Summary of Benefits for each of the specific plans in your area to determine the exact out of pocket costs.
Plans include a Maximum out of Pocket limit which is a calendar year maximum.