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Anthem SmartValue Private Fee for Service (PFFS)

PW_AD089150
Click here for PFFS plan details and benefits.
Click here for PFFS service areas.
 

What is a PFFS plan and how does it work?

A PFFS plan is a type of Medicare Advantage plan whose coverage can, in many ways, offer you the most flexibility. You can choose your own doctors and hospitals and the benefits covered are quite extensive. Inpatient and outpatient services, equipment and home health services all are covered, as are preventative services and diagnostic testing.  
Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing health care services to you with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to you, except in emergencies.  
Part D (Prescription Drug) Coverage
Some Anthem SmartValue PFFS plans also offer Medicare Part D prescription drug coverage. If you select one of these plans, you don’t need to enroll in a separate Part D plan.  

What are the advantages of an Anthem SmartValue PFFS Plan?

The main advantage is that you are free to choose any doctor, specialist or hospital you like as long as they accept Medicare and agree to the plan’s terms and conditions. There is no network that you must limit yourself to and there are no referrals needed to see a specialist.  
Another advantage is that you get access to hundreds of preventive and wellness programs, discounts on products and services, and tools and kits that can help educate and guide you about ways to live a healthier lifestyle. These are extras that Original Medicare does not offer.  
What are the costs?
Whenever you visit a doctor or have a medical service performed, you’ll be asked to pay a small copayment at the time of service just like most other plans. Prior notification may be required for some treatments.  
Who should choose an Anthem PFFS plan?
If seeing the doctor of your choice, and not being limited to a network is important to you, then an Anthem PFFS plan might be right for you.  
Who is eligible?
You are eligible for an Anthem PFFS plan if you are entitled to Medicare Part A and enrolled in Part B and do not have end-stage Renal Disease, if you live in the plan’s service area and if you do not have other coverage that would pay for services before your deductible is met.  
How do I choose an Anthem PFFS Plan?
The best way to choose is by comparing the coverage and rates. You can do this by clicking here.  
There are differences between a Private Fee-for-Service plan and a Medicare Supplement plan.  
A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to agree to accept the plan’s terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan’s terms and conditions here.  
 
Click here to enroll.  
 
 
CMS Approved Date 09/2008, Material Identification M0013_09_041
Last Updated 09/2008  
 
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use