If Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the DSNP, what is her responsibility for cost sharing?

The correct answer reflects that if Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the Dual Special Needs Plan (DSNP), she is responsible for all forms of cost-sharing associated with her Medicare coverage. This includes premiums, deductibles, copayments, and coinsurance.

When someone loses Medicaid coverage, they typically revert to standard Medicare benefits without the assistance that Medicaid provides, which can include significant cost-sharing reductions. DSNPs are designed to provide additional benefits beyond standard Medicare, often covering costs that members would otherwise have to pay. Therefore, without the DSNP, Lucille will be responsible for all costs that would normally fall to a Medicare recipient, including monthly premiums for Medicare Part B or Part D, any Medicare deductibles (the amounts owed before coverage kicks in), copayments (set amounts for services), and coinsurance (a percentage of costs for services).

This comprehensive responsibility for cost sharing can impose a financial burden, particularly for those who previously relied on Medicaid and DSNP benefits to help mitigate these expenses. Understanding this transition is crucial for individuals navigating changes in their health care coverage.