Dual Eligible definition

Dual Eligible means a Medicare managed care recipient who is also eligible for Medicaid, and for whom HHSC has a responsibility for payment of Cost Sharing Obligations under the Texas State Plan. For purposes of this Agreement, Dual Eligible individuals are limited to the following categories of recipients: QMB Only, QMB Plus, and SLMB Plus.

Dual Eligible means an individual who is entitled to Medicare Part A and/or Medicare Part B and is eligible for some form of Medicaid. The MA Health Plan may enroll only those categories of Dual Eligible individuals identified in Appendix A.

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.”

Examples of Dual Eligible in a sentence

• Cost Sharing Obligations mean those financial payment obligations incurred by HHSC in satisfaction of the Deductibles, Coinsurance, and Co-payments for the Medicare Part A and Part B programs with respect to Dual Eligible Members.

• The MA Dual SNP has agreed to provide services relating to Other Dual SNP Members, as identified in this Agreement, as part of the consideration for receiving the PMPM capitation payment for Dual Eligible Members.

• Neither the MA Dual SNP nor its Network Providers will seek additional payment from HHSC, Dual Eligible Members, or healthcare providers for such Cost Sharing Obligations.

• The MA Dual SNP must inform Network Providers of the Medicare benefits and Medicaid LTSS available to Dual Eligible Members and Other Dual SNP Members.

• If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNP: (1) will lose the opportunity to receive the per member per month capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

More Definitions of Dual Eligible

Dual Eligible means a MA Member who is eligible for both Medicare and Medicaid benefits.

Dual Eligible means a person eligible for Medicare who is also eligible for Medicaid (dual eligible) is in a medical institution that is funded by Medicaid for a full calendar month, the dual eligible person is not required to pay co-payments for their Medicare covered prescription medications for the remainder of the calendar year.

Dual Eligible means a Medicare recipient who is also eligible for Medicaid, and for whom the State has a responsibility for payment of Cost Sharing Obligations under the Georgia State Plan. For purposes of this Agreement, Dual Eligibles are limited to the following categories of recipients: Full Benefit Dual Eligibles, QMB Only, SLMB, and SLMB Plus.

Dual Eligible means a Member who is eligible for both Medicare and Medicaid. There are two types of Dual Eligible Members: a

Dual Eligible. An individual who has established eligibility for Medicare as their primary coverage and Medicaid as their secondary coverage.

Dual Eligible means a Medicare managed care recipient who is also eligible for Medicaid, and for whom the State has a responsibility for payment of Cost Sharing Obligations under the Washington State Plan. For purposes of this Agreement, Dual Eligibles are limited to the following categories of recipients: QMB Plus, SLMB Plus

Dual Eligible means an individual eligible for Medicare and Medicaid benefits.