Plan Overview & Benefits

BlueMedicare PFFS is a Medicare Advantage Private Fee-for-Service Plan offered by Blue Cross and Blue Shield of Florida (BCBSF). It is not a HMO, PPO or Medicare Supplement policy. This plan is available as an alternative to Original Medicare to Medicare-eligible individuals in Florida and to Florida employer groups with retirees across the country. It combines the benefits of Medicare Parts A and B and includes additional services not covered by Original Medicare such as:

• Prescription drug coverage (Medicare Part D);
• $0 deductibles and no health services coinsurance;
• Low, fixed, predictable copayments;
• A variety of preventive services with no copayments; and
• No referrals are required.

Since there is no physician, hospital or other health care provider network, members may see any Medicare-approved health care provider that accepts the BlueMedicare PFFS Terms and Conditions of Payment (PDF). When providers knowingly choose to extend services to a BlueMedicare PFFS member, they are acknowledging they accept the plan's Terms and Conditions of Payment.*

With BlueMedicare PFFS, health care providers:

• Have no contracts to negotiate or sign;
• File claims directly with Blue Cross and Blue Shield of Florida (BCBSF) - electronically via Availity^®; paper claims by mail. And all standard HIPAA electronic transactions are accepted;
• Will be promptly reimbursed from BCBSF at the same rate Medicare pays for all Medicare-covered services, minus any applicable member copayments*. For more information on reimbursement, please refer the BlueMedicare PFFS Payment Methodology Grid (PDF)
• And can rely on a dedicated, highly trained operations center staff that is focused on educating prospective members to ensure they understand the plan prior to enrollment.

Additional BlueMedicare PFFS information is available below:

• Frequently Asked Questions (PDF)
• What Providers and People on Medicare Need to Know about Private Fee-For-Service Plans (PDF)
• BlueMedicare PFFS Benefit Tables (PDF)

BlueMedicare PFFS for Individuals:

• 2009 BlueMedicare PFFS Summary of Benefits (PDF)
• 2009 BlueMedicare PFFS Evidence of Coverage (PDF)
• 2009 BlueMedicare PFFS Comprehensive Formulary (PDF)

BlueMedicare Group PFFS:

• 2009 BlueMedicare Group PFFS, Plan 1, Rx 1 Summary of Benefits (PDF)
• 2009 BlueMedicare Group PFFS, Plan 1, Rx 2 Summary of Benefits (PDF)
• 2009 BlueMedicare Group PFFS, Plan 1, Rx 3 Summary of Benefits (Coming soon)
• 2009 BlueMedicare Group PFFS, Plan 2, Rx 1 Summary of Benefits (Coming soon)



• 2009 BlueMedicare Rx Comprehensive Formulary - Options 1 and 2 (PDF)

*Provider must be eligible to receive payment by Medicare and accept the BlueMedicare PFFS Terms and Conditions of Payment (PDF).

BlueMedicare PFFS has a Medicare Advantage contract approved by the Centers for Medicare & Medicaid Services. Contracts are renewed annually and availability of coverage beyond the end of the current contract year is not guaranteed. A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. A doctor or hospital must agree to accept the plan's terms and conditions prior to providing health care services to a member, with the exception of emergencies. If a doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to the member, except in emergencies.