Fee-for-Service Health Plans Described

Most Fee-for-Service (FFS) plans will allow you to use any healthcare provider and facility you wish to use. Your monthly premium is usually lower than that of a Preferred Provider Organization plan. Typically, co-pays for doctors' visits do not go towards satisfying/paying your deductible.

You are expected to pay a discounted/contracted rate for medical services until your deductible is met. Once your deductable is met, your insurance carrier will pay a percentage of bills charged. An out-of-pocket maximum is in place for the FFS plan, however, in the case of the FFS plan, your deductible does not count towards your out-of-pocket maximum.

There are two types of FFS policies, a basic and major policy. The basic plan covers some physician visits, hospitalization stays and prescriptions. The major plan covers serious, long-term illnesses. Some insurance agencies combine both the basic and major policy into one comprehensive plan

The benefits included in fee-for-service plan vary greatly. It is important to review each plan to see if immunization and preventative medicine (routine examinations) are covered benefits. You may also wish to confirm whether therapy services and DME are part of the covered basic medical benefit. In most cases, experimental and investigational treatments are not a covered benefit.

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