How PFFS Plans Work

HealthMarkets Care Assured^SM (“Care Assured” or the “Plan”) is a Medicare Advantage Private Fee-For-Service (PFFS) plan, under a contract with the Centers for Medicare and Medicaid Services (CMS). A Medicare Advantage PFFS 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 download the plan’s Terms and Conditions.

With a PFFS Plan such as Care Assured, you can go to any Medicare-eligible provider who is willing to accept the Plan’s terms and conditions of payment — you are not restricted to providers on a list.

Simply advise your provider that you are a member of Care Assured when you make your appointment. At the time of service, present your Care Assured ID Card and make the applicable copayment. No referrals or prior authorizations are necessary.

If your provider accepts Care Assured’s terms and conditions of payment, that provider is considered “deemed” and available to can render covered services to you. If a provider decides not to accept Care Assured’s terms and conditions of payment, contact us so we may assist you in finding a provider who will accept the Plan.

Care Assured recommends that you complete the Provider Contact section of the enrollment form so we can send your chosen providers all the information they need about Care Assured in advance.

You are not required to give any information to HealthMarkets, and any information you do provide will not affect your ability to enroll in our plan. Any information you provide will be kept confidential and not be provided to any other organization.

Enter your ZIP CODE to review Care Assured Plans in your area.

How PFFS Plans Work