How does private fee for service coverage work?

Who is this for?

Learn more about your Medicare Plus Blue PPO plan.

If you're new to our Blue Cross® Medicare Private Fee for Service plan, this will help you learn how your plan coverage works.

When joining a new health care plan, you'll want to understand your coverage and whether you have to pay out-of-pocket for benefits.

With the Blue Cross Medicare PFFS plan, you can choose to see an in-network or out-of-network doctor. You'll pay the same amount for care whether you are in or out of network. When you get care in this network, we decide how much we'll pay doctors and how much you'll have to pay. You'll be able to see doctors in these 56 counties.

If you choose, you can also get care anywhere else in the country that accepts Medicare, but if you choose an out-of-network doctor, you may pay more.

What's covered?

This plan covers all medical care provided by Medicare Part A and Part B. Medicare Part A helps cover your inpatient hospital care. Part B helps covers services like doctors’ visits and outpatient care. These plans also cover preventive services and an annual physical exam.

How to find your doctor

You can search for doctors and hospitals in the PFFS network by typing in a doctor, hospital or specialty you're looking for and hitting Search.

What do I need when I go to the doctor?

Regardless of where you go for care, you’ll want to be sure to find out if the doctor or hospital accepts the Blue Cross Medicare PFFS plan.

You’ll need to show your Blue Cross ID card every visit. Before you get care, be sure to ask your doctor or hospital if they’re willing to contact Blue Cross with the information provided on your card to verify if you’re covered. You can also check our provider toolkit for our terms and conditions.