Partial dual eligible definition

Partial dual eligible means a Medicare beneficiary who does not meet the requirements for Medicaid Health Coverage, but who is eligible for the State’s Medicare Premium Payment Program (MPP).

Partial dual eligible beneficiary means those categories of individuals indicated in Attachment A that are eligible for Medicare benefits as well as Medicaid coverage of assistance in paying Medicare Part A and/or Part B premiums, and Cost-Sharing Obligations for Medicare-covered services.

Examples of Partial dual eligible in a sentence

• Partial dual eligible individuals and LIS applicants do not qualify for retroactive assignments.

• Partial dual eligible members include Qualified Medicare Beneficiaries (QMBs) and Specified Low Income Medicare Beneficiaries (SLMBs) who qualify to receive Medicaid support for Medicare premiums and cost-sharing.

• Two Medicaid populations that are eligible for certain medical benefits are not eligible for behavioral health services through the Medicaid program: (1) Non-citizens; and (2) Partial dual- eligible individuals (i.e., individuals who are eligible for both Medicare and Medicaid benefits, but for whom the Medicaid benefit is limited to payment of Medicare premiums and co- insurance payments).

• N = 65.9 million Medicare beneficiaries.Medicare Advantage & Dual Eligible Special Needs Plans Partial dual eligible individuals are more similar to full dual eligible individuals than non-dual individuals.All Medicare beneficiaries who are enrolled in both Medicare Parts A & B are eligible to enroll in a MA plan.

• Partial- dual eligible beneficiaries are not entitled to full Medicaid benefits and generally only receive help with Medicare premiums and, in some cases, cost sharing.

• Partial dual eligible (QMB, SLMB, QI1).Choice Counselors are available to assist recipients in selecting a plan that best meets their needs.

• Partial dual eligible enrollees are not enrolled in Medicaid managed care nor are they eligible for the full suite of Medicaid benefits.

• Partial dual eligible individuals have limited MaineCare insurance through the Medicare Savings Program (MSP) that only helps pay for Medicare cost sharing expenses.