Under what condition should you enroll a dual eligible customer into a PFFS plan?

Enrolling a dual eligible customer into a Private Fee-for-Service (PFFS) plan is primarily guided by the individual's preferences and requests. When a customer actively requests to be enrolled in a PFFS plan, it indicates that they have a specific interest in the benefits or features offered by that plan, which may include flexibility in choosing healthcare providers or additional benefits not covered by traditional Medicare.

This approach aligns with the principle of beneficiary choice, ensuring that individuals are in control of their health coverage. It also reflects the importance of personal circumstances and financial situations when making such decisions. Accordingly, enrolling someone based solely on their express request fosters an advocacy-based model in healthcare support, promoting satisfaction and engagement among dual eligible beneficiaries.

While factors like completing a health screening or income requirements may influence what plan would be best suited for a customer, these considerations do not form a prerequisite for enrollment into a PFFS plan. Moreover, addressing uncertainty requires careful consideration of the customer's needs rather than committing them to a plan without their express interest.