MEDICARE AND MEDICAID OR MEDICAID ONLY Sample Clauses

MEDICARE AND MEDICAID OR MEDICAID ONLY. If you have Medicare and Medicaid, you will usually not have a participant payment. You may be liable for any applicable spenddown liability and any amounts due under the post-eligibility treatment of income process. As a Saint Xxxxxx XXXX participant, you will automatically receive all prescription drug and healthcare benefits from Saint Xxxxxx XXXX. Saint Xxxxxx XXXX has a contract with Medicare to provide you with prescription drug coverage at no cost to you. MEDICARE ONLY If you have Medicare only and are not eligible for Medicaid, then you will pay a monthly premium to Saint Xxxxxx XXXX. Your monthly premium of $ starts on (date). Because this premium does not include the cost of Medicare prescription drug coverage, you will be responsible for an additional monthly premium for Medicare prescription drug coverage in the amount of $ . If you have Medicare, you will still pay the monthly Medicare Part B bill to the Social Security Administration. PRIVATE PAY (NEITHER MEDICARE OR MEDICAID) If you are not eligible for Medicare or Medicaid, then you will pay a monthly premium to Saint Xxxxxx XXXX. Your monthly premium of $ starts on (date). Because this premium does not include the cost of Medicare prescription drug coverage, you will be responsible for an additional monthly premium for Medicare prescription drug coverage in the amount of $ . PRESCRIPTION DRUG COVERAGE LATE ENROLLMENT PENALTY AND MEDICARE BENEFITS Please be aware that if you are eligible for Medicare prescription drug coverage and are enrolling in Saint Xxxxxx XXXX after going without Medicare prescription drug coverage that was at least as good as Medicare drug coverage for 63 or more consecutive days, you may have to pay a higher amount for Medicare prescription drug coverage. If you become eligible for Medicare after enrollment in PACE, you must obtain all Medicare coverage (Parts A and/or B, and Part D) from Saint Xxxxxx XXXX. FAILURE TO PAY PARTICIPANT OBLIGATION You are enrolled the first day of the following month once the enrollment agreement is signed. If you have a participant payment, you must make payments by the end of each month or within the 30-day grace period after the end of the month in which payment was due. If you do not pay your bill, you may be disenrolled from the program. If you can’t pay, you must call Saint Xxxxxx XXXX to plan how you will make up the late payments. If you pay the amount you owe before the effective date of disenrollment, you will remain in the pr...
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MEDICARE AND MEDICAID OR MEDICAID ONLY. If you are eligible for both Medicare and Medicaid, or Medicaid only, you will make no monthly premium payment to Fallon Health Xxxxxxxx-XXXX, and you will continue to receive all PACE services, including prescription drugs. Note: If you are responsible to pay a spend-down to be eligible for Medicaid, you will need to pay this spend-down monthly to Fallon Health Xxxxxxxx-XXXX. Those individuals applying for Medicaid who are deemed ineligible will be responsible for paying applicable retroactive premiums as shown below.
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MEDICARE AND MEDICAID OR MEDICAID ONLY. If you have Medicaid and are eligible for both Medicare and Medicaid, you are not responsible for any premiums, but may be responsible for any applicable spenddown liability under federal law and any amounts due under the post-eligibility treatment of income process. In order to qualify for Medicaid, you may be required to make a payment to Trinity Health PACE Alexandria. The Medicaid agency will determine whether you have to make a payment to Trinity Health PACE Alexandria each month to qualify for Medicaid coverage. The amount you have to pay Trinity Health PACE Alexandria is based on your income or the income of your household. As a Medicaid recipient and a Trinity Health PACE Alexandria participant, you will never pay a co-payment, deductible, or co-insurance for approved services. The payment paid to Trinity Health PACE Alexandria by Medicare/Medicaid will be considered “payment in full” for all approved services other than nursing facility care. As a Trinity Health PACE Alexandria participant, you will automatically receive all prescription drug and healthcare benefits from Trinity Health PACE Alexandria. Trinity Health PACE Alexandria has a contract with Medicare to provide you with prescription drug coverage at no cost to you. MEDICARE ONLY If you have Medicare only and are not eligible for Medicaid, then you will pay a monthly premium to Trinity Health PACE Alexandria. Your monthly premium of $ starts on (date). Because this premium does not include the cost of Medicare prescription drug coverage, you will be responsible for an additional monthly premium for Medicare prescription drug coverage in the amount of $ . If you have Medicare, you will still pay the monthly Medicare Part B bill to the Social Security Administration.
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Related to MEDICARE AND MEDICAID OR MEDICAID ONLY

  • Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S RESOURCES. Services reimbursed under Medicaid are outlined in Attachment “A” to this Agreement. Once a Medicaid application has been submitted on the Resident’s behalf, the Resident, Sponsor, and Resident Representative agree to pay, to the extent they have access to the Resident’s funds, to the Facility the Resident’s monthly income, which will be owed to the Facility under the Resident’s Medicaid budget. Medicaid recipients are required to pay their Net Available Monthly Income (“NAMI”) to the Facility on a monthly basis as a co-payment obligation as part of the Medicaid rate. A Resident’s NAMI equals his or her income (e.g., Social Security, pension, etc.), less allowed deductions. The Facility has no control over the determination of NAMI amounts, and it is the obligation of the Resident, Resident Representative and/or Sponsor to appeal any disputed NAMI calculation with the appropriate government agency. Once Medicaid eligibility is established, the Resident, Resident Representative and/or Sponsor agree to pay NAMI to the Facility or to arrange to have the income redirected by direct deposit to the Facility and to ensure timely Medicaid recertification. The Resident, Sponsor and Resident Representative agree to provide to the Facility copies of any notices (such as requests for information, budget letters, recertification, denials, etc.) they receive from the Department of Social Services related to the Resident’s Medicaid coverage. Until Medicaid is approved, the Facility may bill the Resident’s account as private pay and the Resident will be responsible for the Facility’s private pay rate. If Medicaid denies coverage, the Resident or the Resident’s authorized representative can appeal such denial; however, payment for any uncovered services will be owed to the Facility at the private pay rate pending the appeal determination. If Medicaid eligibility is established and retroactively covers any period for which private payment has been made, the Facility agrees to refund or credit any amount in excess of the NAMI owed during the covered period.

  • Family Care and Medical Leave An unpaid Family Care and Medical Leave shall be granted, to the extent of and subject to the restrictions as set forth below, to an employee who has been employed for at least twelve (12) months and who has served for one hundred thirty days (130) workdays during the twelve (12) months immediately preceding the effective date of the leave. For purposes of this section, furlough days and days worked during off-basis time shall count as "workdays". Family Care and Medical Leave absences of twenty (20) consecutive working days or less can be granted by the immediate administrator or designee. Leaves of twenty (20) or more consecutive working days can be granted only by submission of a formal leave application to the Classified Personnel Assignments Branch.

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Health Care Operations Health Care Operations shall have the meaning set out in its definition at 45 C.F.R. § 164.501, as such provision is currently drafted and as it is subsequently updated, amended or revised.

  • Child Care Leave (a) An employee who is a natural or adoptive parent shall be granted upon request in writing child care leave without pay for a period of up to thirty-five (35) weeks. The leave may be shared by the parents or taken wholly by one (1) parent.

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