What costs are D-SNP members responsible for if they lose eligibility due to a change in Medicaid status?

Dually Eligible Special Needs Plan (D-SNP) members are individuals who qualify for both Medicare and Medicaid. When a D-SNP member loses their eligibility for Medicaid, typically due to a change in their income or other circumstances affecting their Medicaid status, their financial responsibilities alter significantly.

Members who previously benefited from the financial protections and low or no cost-sharing under Medicaid may now need to cover the full gamut of health care costs associated with their Medicare coverage. This includes premiums, deductibles, copayments, and coinsurance. The loss of Medicaid eligibility means that the safety net that Medicaid often provides is no longer available, thereby shifting the financial burden to the member.

Therefore, the correct understanding is that D-SNP members who lose their Medicaid status are responsible for all costs related to their Medicare coverage, making their financial situation much more complex and potentially more costly. This reflects the broader implications of eligibility transitions and necessitates awareness among members to prepare for or respond to such changes effectively.