In California, when a beneficiary who is eligible for both Medicare and Medi-Cal enrolls in a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP), the Medicare cost-sharing amounts (deductibles, coinsurance, and copayments) are generally:
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Dual-eligible Special Needs Plans (D-SNPs) serve beneficiaries entitled to both Medicare and Medi-Cal. For these dual-eligible members, Medi-Cal acts as the wrap-around payer that covers the Medicare cost-sharing amounts — the deductibles, coinsurance, and copayments that Medicare alone would leave to the beneficiary. This share-of-cost protection is a central feature of D-SNP membership in California. Option A correctly describes how cost-sharing is handled for dual-eligible D-SNP enrollees. This arrangement keeps care affordable for low-income seniors by using Medi-Cal as the wrap-around payer for the cost-sharing that Medicare leaves behind.
Why the other options are wrong
- B) The federal government does not waive Medicare cost-sharing for dual eligibles; it is Medi-Cal, the state Medicaid program, that pays those amounts on the beneficiary's behalf. No federal waiver exists; the state Medicaid program is what actually pays the share of cost.
- C) Dual-eligible beneficiaries are shielded from most cost-sharing through Medi-Cal; leaving them to pay everything out of pocket defeats the purpose of the D-SNP design. The D-SNP design exists precisely to shield dual eligibles from out-of-pocket cost-sharing burdens.
- D) COBRA is continuation of employer group coverage for former employees and their dependents; it has no role in D-SNP cost-sharing for dual-eligible beneficiaries. COBRA covers former employees of group plans and is entirely unrelated to D-SNP financing.
Memory hook
D-SNP = Medicare leads, Medi-Cal picks up the tab. Dual eligible means the state pays your share of cost.