Dual Eligible refers to an individual who meets the requirements to receive benefits from both the Federal Medicare Program and the Wisconsin Medicaid Program. “Dual eligibility” does not guarantee “dual coverage.”
Dual Eligible. An individual who is entitled to both Medicare coverage (Part A and Part B) as well as some form of assistance under Title XIX (Medicaid), such as payment of a Medicare premium, even if the individual is not eligible for AHCCCS acute or ALTCS services. Dual eligibles include, but are not limited to, persons who are referred to as QMB Only, QMB Dual, SLMB, QI 1, Acute Care Duals and ALTCS Duals.
Dual Eligible. An enrollee who is eligible for both Medicaid (Title XIX) and Medicare (Title XVIII) programs.
Dual Eligible. A person who qualifies for Medicare and Medicaid coverage.
Dual Eligible. For purposes of this document, an adult aged 65 or older who is eligible for and enrolled in Medicare Parts A and B and enrolled in MassHealth Standard coverage. This includes Qualified Medicare Beneficiaries with full Medicaid (QMB Plus) and Low-Income Medicare Beneficiaries with full Medicaid (SLMB Plus) aged 65 or older and with MassHealth Standard coverage.
Dual Eligible. “Dual Eligible” or dually eligible, means individuals who have been determined eligible for both Medicare and Medicaid services.
Dual Eligible. As used in this Contract, a Medicare enrollee who is also eligible for TennCare and for whom TennCare has a responsibility for payment of Medicare Cost Sharing Obligations under the State Plan. For purposes of this Contract, Dual Eligibles are limited to the following categories of recipients: QMB Only, QMB Plus, SLMB Plus, and Other Full Benefit Dual Eligible (“FBDE”).
Dual Eligible. For purposes of this document, an adult aged 65 or older who is eligible for and enrolled in Medicare Parts A and B and enrolled in MassHealth Standard coverage. This includes Qualified Medicare Beneficiaries with full Medicaid (QMB Plus) and Low-Income Medicare Beneficiaries with full Medicaid (SLMB Plus) aged 65 or older and with MassHealth Standard coverage. Effective Enrollment Date - The first calendar day of the month following the receipt of Enrollee’s enrollment into a SCO plan. Eligibility Verification System (EVS) - The online and telephonic system Providers must access to verify eligibility, managed care enrollment, and available third-party liability information about Members. Eligible Individual - An Eligible Individual is a person aged 65 or older, or who turns 65 within the first calendar month of enrollment, who is enrolled in MassHealth Standard and no other comprehensive private or public health coverage. An Eligible Individual may be enrolled in Medicare Parts A and B, but Medicare enrollment is not a requirement for SCO eligibility.
