Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 2/5
Under a Medicare Advantage Private Fee-for-Service (PFFS) plan, a member:
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
A Medicare Advantage Private Fee-for-Service (PFFS) plan sets its own payment rates and pays providers on a fee-for-service basis. Members may obtain covered services from any Medicare-approved provider that is willing to accept the plan's terms and conditions of payment. Unlike HMO plans, a PFFS plan generally does not require a primary care physician or referrals. The plan, not a network, determines how much providers are paid.
Why the other options are wrong
- A) PFFS plans do not require members to use a primary care physician or an in-network gatekeeper.
- C) PFFS plans do not own hospitals or restrict care to plan-owned facilities; any willing Medicare provider may be used.
- D) Referrals are not required in PFFS plans; the provider simply must accept the plan's payment terms.
Memory hook
PFFS = any Medicare doctor who accepts the plan's check. No gatekeeper, no network, no referral slip.