What is a key limitation of PFFS plans regarding healthcare provider payments?

PFFS (Private Fee-for-Service) plans operate under a unique payment structure, which allows them to establish their own payment terms for healthcare providers. A significant limitation of these plans is that they can include balance billing, where providers can charge beneficiaries the difference between what Medicare pays and the provider's charge, up to a predetermined cap. This means that while the plan may cover certain basic costs, beneficiaries could still face additional out-of-pocket expenses depending on the provider's fees.

The ability for PFFS plans to implement balance billing can lead to unexpected financial burdens for enrollees who may not be fully aware of the out-of-pocket limits, hence making this a crucial limitation in understanding how these plans function in a broader healthcare context. This is an important consideration for beneficiaries when selecting their Medicare options, as it directly affects their overall healthcare costs.