What must you advise consumers enrolling in a DSNP?

When advising consumers enrolling in a Dual Special Needs Plan (DSNP), it is crucial to communicate the financial implications and coverage specifics related to their eligibility and access to services. The correct answer highlights that individuals who are Full Dual-Eligible, or those deemed eligible by the DSNP's agreement with the state, are not obligated to make copayments for Medicare-covered services rendered by network providers.

This is a key aspect of the DSNP structure because it recognizes the unique needs and financial constraints of dual-eligible individuals, who qualify for both Medicare and Medicaid. The absence of copayments reduces the financial burden on these consumers and ensures greater access to necessary healthcare services, which is one of the primary objectives of DSNPs.

Furthermore, the mention that providers should bill the state Medicaid program reinforces the coordination of benefits between Medicare and Medicaid. This ensures that the financial responsibility for covered services appropriately falls to the Medicaid program, which is designed to serve low-income individuals and provides comprehensive support beyond what Medicare offers.

In summary, focusing on the lack of copayment requirement for Full Dual-Eligible individuals emphasizes the supportive nature of DSNPs and their role in making healthcare more accessible to vulnerable populations.