Medicare PFFS and MSA Plans: How These Less Common Options Work

Two different designs

Both Are Medicare Advantage Options

A Private Fee-for-Service plan, or PFFS, sets payment terms that providers must accept for the care it covers. A Medicare Medical Savings Account plan, or MSA, combines a high-deductible Medicare Advantage plan with an account funded through the plan. Neither is a Medigap policy.

Availability depends on your location and coverage year. Finding an explanation of a plan type does not establish that an insurer offers it in your county. Check Medicare Plan Compare before building a comparison around one of these options.

PFFS access

“Accepts Medicare” Is Not the Whole Question

For PFFS, ask whether the provider accepts the particular plan’s payment terms and agrees to treat you. Some PFFS plans have a contracted network. Outside such an agreement, a provider can decide at each visit whether to accept the terms. Confirm before scheduled care even if a previous visit went smoothly.

PFFS plans do not require a primary-care doctor or specialist referral. Some include Part D and others do not. If the PFFS plan has no drug coverage, a separate Part D plan can provide it. Show the PFFS membership card and follow the plan’s instructions.

MSA structure

Understand the Gap Between the Deposit and Deductible

An MSA plan deposits funds into the designated account. You use available money for qualifying expenses, while the plan’s high-deductible medical coverage begins after its deductible is met. The deposit may be smaller than the deductible, leaving you responsible for the difference when you need enough covered care.

MSA plans do not include Part D. Review separate prescription coverage and its costs. They generally do not use provider networks, but the provider must agree to treat you and meet Medicare requirements. Check how claims count toward the plan deductible, rather than assuming every account purchase counts.

Compare the responsibilities

Questions for Each Plan Type

Eligibility and other coverage

An MSA Is Not Available in Every Situation

Medicare lists important MSA restrictions involving Medicaid, certain other coverage, TRICARE or VA benefits, hospice and time spent outside the United States. Review the complete eligibility list with the plan. Do not drop another valuable benefit just to make an MSA comparison possible.

An MSA is also different from an employer Health Savings Account. Contributions, account use and tax reporting follow their own rules. Discuss tax questions with a qualified tax professional and review the plan’s written account instructions.

Before enrolling

Compare the Whole Coverage Arrangement

Write down your doctors, hospitals, prescriptions, expected care and savings available for bills. Compare these less common arrangements with the HMO and PPO options and Original Medicare with appropriate supplemental coverage.

If “high deductible” is the term that brought you here, high-deductible Medigap Plan G explains a different product. Matching names should never replace checking what coverage is actually being offered.