Which statement is true of D-SNP members?

• A. They must pay copayments for Medicare-covered services.
• B. They are not eligible for Part D.
• C. They generally are not required to pay copayments for Medicare-covered services obtained from a D-SNP in-network provider in the state in which they live.
• D. They can only use out-of-network providers.

Answer: (C)

D-SNPs are designed for people who qualify for both Medicare and Medicaid, and they coordinate benefits to reduce out-of-pocket costs for Medicare-covered services when you use in-network providers in your home state. Because Medicaid often covers these cost-sharing amounts, a dual-eligible enrolled in a D-SNP typically wouldn’t pay copayments for Medicare-covered services from an in-network provider in the state where they live. This is why the statement is true—the plan’s design and state Medicaid cost-sharing arrangements reduce or eliminate copays in-network. The other options don’t fit: copays aren’t universally required for all Medicare-covered services under a D-SNP, Dual-eligibles generally have Part D drug coverage through the plan, and while out-of-network use can occur, it isn’t the only option or a requirement.