Before enrolling a customer into a Private Fee-for-Service (PFFS) plan, what should you ask them?

When considering enrollment in a Private Fee-for-Service (PFFS) plan, it is essential to confirm whether the potential member is enrolled in a state Medicaid program. This is because PFFS plans typically have specific eligibility requirements, and Medicaid enrollment may affect the individual's ability to enroll in such a plan. In many cases, individuals who are already eligible for Medicaid may find that a PFFS plan doesn't provide additional benefits, or they may be subject to particular coordination of benefits rules that impact how services are paid for and what costs they may incur.

Understanding a customer's Medicaid enrollment status is crucial because it can influence not only their eligibility for the PFFS plan but also the overall cost structure of their healthcare coverage. Thus, this inquiry supports informed decision-making for the prospective member regarding their health insurance choices.