Fee For Service (FFS) Insurance: The Pros and Cons
Key Takeaways
FFS is one of the most expensive forms of insurance with high out-of-pocket costs. You’ll also need to file claims with your insurance company to get reimbursed.
FFS beneficiaries can see any doctor they want and don’t need referrals from a primary care physician.
If you have a Fee For Service health insurance plan, you pay a flat fee for any services you receive. You then file a claim to your insurance company for reimbursement. Since FFS customers typically pay upfront, they can visit any doctor or hospital with limited hassle.
While FFS plans are not nearly as popular as they used to be, they are still available. If you’re shopping for health insurance or helping a loved one with their options, here’s what you can expect from an FFS plan.
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The Pros of a Fee For Services Health Plan
FFS customers don’t have provider networks and typically enjoy the freedom to see any doctor they want. This can be a massive advantage if you spend a lot of time traveling. You also won’t need to see a primary care physician or need referrals to see specialists. Plus, many providers will even negotiate pricing with customers who have FFS plans to help them control out-of-pocket costs.
- No provider networks: see any doctor you want, anywhere
- No referrals or pre-approvals: just make an appointment and go
- May negotiate rates: Some doctors will lower their prices for FFS customers
The Cons of a Fee For Services Health Plan
Just a few years ago, more people were enrolled in an FFS plan than any other type. Now, it’s just the fifth most-popular type of health insurance policy. The main reason for this is because health insurance began shifting its focus to value-based care. Under FFS plans, if you get sick or injured, you pay the doctor to treat you. That approach leaves out preventable diseases or injuries. FFS plans don’t offer the same kind of personal, managed care that other plans provide. While you can still receive preventive services and other essential health benefits with an FFS plan, keeping up with them is up to you.
FFS also became known for its charges. Critics say that an FFS approach causes doctors to force their patients into unnecessary services and treatments to line their pockets.
Lastly, FFS plans are among the most expensive. You’ll generally have high deductibles and out-of-pocket costs to pay, along with a monthly premium.
- Costly: FFS plans have high out-of-pocket costs
- Less managed care: No primary care physician to remind or monitor you
- Upfront costs: pay your doctor directly, file a claim, then get reimbursed
Are you eligible for cost-saving Medicare subsidies?
How Can I Enroll In an FFS Plan?
You can shop all the plans available in your area by going to federal or state health insurance marketplaces, or exchanges.
FAQs
Fee For Service may not be as popular as it used to be, but some customers are still willing to pay upfront costs and wait for reimbursement for seeing any doctor they want. As with all health insurance, it can be a complex topic.
