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Medicare Fee-for-Service Plans

Written by Evens Stevenson

While Medicare gives you health care coverage that you wouldn’t be able to afford otherwise, there are some holes in the coverage. Millions of Medicare enrollees aren’t satisfied with their health care coverage and look for additional protection. One of the ways that you can get more insurance coverage is by enrolling in a fee-for-service plan.

There is a lot of confusion surrounding these fee-for-service plans, but they can be a great tool to help supplement your basic insurance coverage. If you’re looking to participate in one of these fee-for-service supplemental plans, there are some things that you should know.

What Are Private Fee-for-Service Plans?

medicare fee for service plansTo put it simply, a fee-for-service plan is a Medicare Advantage plan that is offered by a private insurance company. With these plans, the reimbursement with the insurance company works a little differently than the other plans. Every month Medicare will pay the insurance company a predetermined amount of money for the company to provide health insurance to the people with Medicare.

Unlike traditional Medicare, with these private plans, the insurance company decides how much they will pay for certain services and how they are covered under the plan. In some cases, this can be a beneficial change, in other situations, it can be detrimental.

Much like other forms of supplemental coverage, not all plans are available in every state. Each state and company can offer different plans, which means that you’ll have to research different companies to see which plans are available to you in your area.

With the private fee-for-service plans, you’ll be able to go to any provider that accepts your service plan. This won’t give you as much flexibility as a Medigap plan, but most enrollees never have any problems finding providers inside of their plan’s network. Each provider can decide if they want to accept your plan or not, they also have the right to stop accepting the plans terms of conditions at any point if they choose. If they don’t accept the terms of the plan, you shouldn’t receive services from them unless in a medical emergency.

One thing that you should take note of is every time that you go to a provider, you’ll have to present your plan ID card to verify that you’re enrolled in the plan. If you don’t have your ID card with you, the provider won’t be able to verify who you are and will not be allowed to give you the treatments or services.

What You Will Pay In A Fee-For-Service Plan

One of the biggest factors that applicants are considered with when they start looking for supplemental coverage is how much is it going to cost them, which is a valid question. With fee-for-service policies, there are several different factors that are going to impact how much you pay for your coverage.

The first is how much the insurance company is going to charge in monthly premiums. Each company is different, and they all will charge different amounts for their coverage. If you’re looking to get the most affordable coverage, you’ll want to get quotes from dozens of companies before you choose the one that works best for you.

Another factor that is going to impact how much you pay inside of your plan is how much the decide to charge for their services and how much you’ll be responsible for paying. Every insurance provider is different, and they will all cover different expenses and different portions of those expenses, which will have a huge impact on how much you pay for health care.

Another aspect that could impact your out-of-pocket expenses is how much or how often you receive health care or services. Obviously, the more services and health care that you get, the more that you’re going to pay.

Alternatives To Fee-For-Service Plans

Before you purchase any additional coverage, you should look at all of your options and find the one that works best for you. One of the most popular options for getting more health care coverage is to purchase a Medigap policy. These policies are also sold by private insurance companies but have several distinct differences from fee-for-service plans.

One of the main differences is that you won’t have to worry about finding health care providers that are in your network. With Medigap policies, they are effective at any doctor or hospital that accepts Medicare reimbursement payments. This gives you the freedom to use just about any provider on the market.

Another difference is that with a Medigap plan, you won’t get the additional benefits that some fee-for-service plans offer, like vision, hearing, or dental coverage. While you won’t get these added advantages, you won’t pay as much for the coverage. If you’re looking for the most affordable insurance, a Medigap policy is probably going to save you money.

Each available medigap plan covers various expenses left behind by Medicare, like Part B excess charges or foreign medical emergency fees. These policies are a great way to fill in the gaps that Medicare doesn’t cover, but choosing between the plans can be tricky. Finding the best supplement plan will depend on some factors.

Your health is one aspect that could change the plan you choose. If you’re in perfect health with no pre-existing conditions, then you can consider skipping the fee-for-service policy and going with a less comprehensive Medigap plan and save money every month. On the other hand, if you have poor health or any pre-existing conditions, you’ll want to consider getting a more involved Medigap plans that cover all of the holes left in Part A and Part B, like Medigap Plan F.

Another factor that you’ll need to look at before you decide what option is best for you is your budget. Most people would like to purchase supplemental insurance that covers everything, but not everyone can afford those monthly premiums. Before you apply for a fee-for-service policy or a Medigap plan, look at your budget and calculate how much extra money you can spend on additional coverage.


Fee-for-service plans are a nice way to buy extra protection for your basic Medicare plan, but they aren’t for everyone. You’ll need to weigh the advantages and disadvantages of all your options.

Thinking of buying a fee-for-service plan? Reach out to our agents and they’ll provide you with the information you need to make the best decision. Healthcare is one of the most important parts of your life, don’t leave it up to chance. Not having adequate coverage could leave you with thousands of dollars in medical bills that you have to pay for out of your own bank account.

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