When a member loses eligibility for the Dual Special Needs Plan (DSNP) due to a change in Medicaid status, what type of cost sharing are they responsible for?

When a member loses eligibility for the Dual Special Needs Plan (DSNP) due to a change in Medicaid status, they become responsible for all forms of cost sharing, including premiums, deductibles, copayments, and coinsurance. This is because the DSNP is designed to provide additional benefits and lower cost-sharing requirements for those who are eligible for both Medicare and Medicaid. When their Medicaid eligibility changes, they may lose the financial support that helped cover these costs under the DSNP, thus making them fully responsible for any associated expenses.

This change emphasizes how crucial it is for members to stay informed about their Medicaid status and its implications. Without Medicaid support, all costs associated with their Medicare coverage revert to the member's responsibility, essentially reflecting a standard Medicare cost structure without the added benefits provided by having dual eligibility.