Information for Patients
on Medicare Advantage Private Fee for Service (MAPFFS) Plans
MAPFFS plans are a new product, made possible by the Medicare Modernization Act (which brought us Part D). Patients and doctors have little experience with them. Watch out for hard-sell or “bait and switch” tactics.
MAPFFS plans are a great deal for the government. For a predictable payment of between $700 and $1,200 per month per beneficiary, the government has no further responsibility for the patient's hospital stays, out-patient treatment, or drugs.
MAPFFS plans are very profitable for insurers. At an average $900 per head, they get $10,800 per year, up front, for every person they sign up–no matter what.
MAPFFS plans may offer advantages to patients. Some may give up their overpriced Medicare supplements (but they may not be able to get them back!). Patients may have lower copayments and possibly can self-refer to specialists.
But remember: any service or item a patient receives is a loss for the plan!
Things to consider, and questions to ask:
- Are your preferred doctors and hospitals willing to accept the plan's payments or requirements (such as filing electronic claims)? There's no network; you need to check with each and every doctor before you make an appointment.
- What's the plan's track record on responding to complaints–and how many complaints does it get? Maybe you don't want to be among the first to sign up.
- What if you don't get what you need from the plan? Can you change plans, or get back into traditional Medicare? If so, how long must you wait?