What is not required of Full Dual-Eligible members when receiving Medicare-covered services from a DSNP network provider?

Full Dual-Eligible members who receive Medicare-covered services from a DSNP (Dual Eligible Special Needs Plan) network provider typically have certain protections and benefits that differentiate their care experience from that of regular Medicare beneficiaries. Specifically, one of these protections relates to copayments.

Under Medicaid rules, many Full Dual-Eligible individuals are exempt from paying copayments for services covered by Medicare when those services are rendered by a provider that is part of the DSNP network. This exemption is designed to reduce financial barriers to accessing necessary healthcare services for individuals who rely on both Medicare and Medicaid due to their low income or disability status.

While it is important for such members to coordinate their care with Medicaid, choose a primary care provider, and report any changes in income that could affect their benefits, the structure of the DSNP program allows them not to worry about copayments. This facilitates a more straightforward access to care, ensuring that they receive the support and services they need without the burden of additional out-of-pocket costs.