QMB Dual definition

QMB Dual means a person determined eligible under Article 2 of this Chapter for Qualified Medicare Beneficiary (QMB) and eligible for Acute Care services provided for in 9 A.A.C. 22 or ALTCS services provided for in 9 A.A.C. 28. A QMB Dual person receives both Medicare and Medicaid services and cost sharing assistance. For the purpose of Article 2 of this Chapter, QMB includes members defined in A.R.S. § 36-2971(5).
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QMB Dual means a person determined eligible under Article 2 of this Chapter for Qualified Medicare
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Examples of QMB Dual in a sentence

  • A QMB Dual eligible member who receives services under A.A.C.R9-22-2 or A.A.C. R9-28-2 from a registered provider is not liable for any Medicare copayment, coinsurance or deductible associated with those services and is not liable for any balance of billed charges.

  • Refer to AMPM Exhibit 300-3A for more detail regarding Medicaid only members, QMB Dual and Medicare Primary (non-QMB Dual).

  • QMB Dual refers to a member with income not exceeding 100% FPL who qualifies for Medicare under the Federal QMB program and is enrolled in Medicaid.

  • The Administration pays Medicare part A and B premiums for a QMB Dual member enrolled with a contractor in a plan or AHCCCS Fee-For-Service.

  • A QMB+ Dual Eligible Member has no legal obligation to make further payment to a provider or to the MAO for Medicare Part A or Part B cost sharing amounts.

  • A QMB Dual person receiving both Medicare and Medicaid services and cost sharing assistance.

  • Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from balance billing a QMB+ Dual Eligible Member for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments.

  • Qualified Medicare Beneficiary Dual (QMB Dual) - A person determined eligible under A.A.C. R9-29-101 et seq.

  • A QMB Dual eligible member who receives services under A.A.C. 9-22 or A.A.C. 9-28 from a registered provider is not liable for any Medicare copayment, coinsurance, or deductible associated with those services and is not liable for any balance of billed charges.

  • For a QMB+ Dual Eligible Member, AHCCCS shall provide payment of the applicable Medicare Part A premium, the applicable Medicare Part B premium, Medicare coinsurance amounts, and Medicare deductibles for Medicare covered services.

Related to QMB Dual

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  • Participating Marriage and Family Therapist means a Marriage and Family Therapist who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

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