A dual-eligible beneficiary enrolls in a Dual-Eligible Special Needs Plan (D-SNP) in California. Regarding the Medi-Cal share of cost, which statement is correct?

Why A is correct

D-SNPs serve individuals eligible for both Medicare and Medi-Cal, California's Medicaid program. Some dual-eligible beneficiaries have a Medi-Cal share of cost, an amount of their income they must contribute toward medical expenses before Medi-Cal pays. D-SNPs are structured to coordinate Medicare and Medi-Cal benefits for these members, and the plan's benefit design may cover or manage the member's Medi-Cal cost sharing. The D-SNP's dual coordination role is a tested California-specific point. The share of cost is the Medi-Cal analogue of a deductible: the beneficiary pays a monthly amount based on income before Medi-Cal contributes. D-SNPs coordinate the Medicare and Medi-Cal benefits so the two programs complement each other, and the plan's case-management functions help beneficiaries track and satisfy the share of cost.

Why the other options are wrong

• B) Some dual-eligible beneficiaries do have a Medi-Cal share of cost; the D-SNP arrangement addresses it rather than ignoring it. Some dual-eligible beneficiaries do have a monthly Medi-Cal share of cost based on income, so it is not true that they never have one.
• C) Having a share of cost does not disqualify an individual from D-SNP enrollment; that is exactly the population D-SNPs serve. D-SNPs may enroll beneficiaries who carry a share of cost; coordination with Medi-Cal is precisely what the plan is designed to do.
• D) The share of cost is a Medi-Cal cost-sharing obligation for the member, not a Medicare Part B payment. The share of cost is a Medi-Cal cost-sharing obligation, not a benefit that Medicare Part B pays on the beneficiary's behalf.

Memory hook

D-SNP = the bridge between Medicare and Medi-Cal, share of cost included.