If a DSNP member loses eligibility due to a change in Medicaid status, what costs are they responsible for during the grace period?

When a member of a Dual Special Needs Plan (DSNP) loses their eligibility due to a change in their Medicaid status, they temporarily enter a grace period. During this time, it's crucial to understand the financial responsibilities of the member.

Members are expected to cover all costs that are typically associated with their plan. This includes premiums, copayments, and any other out-of-pocket expenses that arise during the grace period. Since the member is no longer eligible for Medicaid coverage, they cannot rely on Medicaid to assist with these costs, making them fully liable for all expenses incurred with their DSNP until their situation is resolved or they establish new eligibility.

This requirement is designed to ensure that members are aware of their financial obligations even as they navigate changes in their coverage status. Hence, the understanding that all costs, such as premiums and copayments, must be covered during the grace period is key to maintaining clarity about the responsibilities of DSNP members in these particular situations.