Which of the following is a potential negative impact of enrolling dual-eligible customers in a PFFS plan?

Enrolling dual-eligible customers in a Private Fee-for-Service (PFFS) plan can lead to potential disruptions in provider access. PFFS plans allow members to see any Medicare-approved provider who accepts the plan’s terms and conditions. However, not all providers have to participate in PFFS plans, which can create situations where dual-eligible customers may find that their preferred providers do not accept the PFFS plan. This can limit their access to care and may necessitate changing providers, which can be challenging for customers who are accustomed to their existing healthcare relationships.

This disruption can be particularly concerning for dual-eligible individuals because they often have complex health needs and may rely on continuity of care with specific providers. In contrast, other choices such as reduced coverage options, increased monthly premiums, and limited prescription drug coverage may not be as directly tied to the structure of the PFFS plan and can vary widely depending on the specifics of the plan and the individual’s choices rather than being inherent risks of enrollment in such plans.