QMB Plus definition

QMB Plus means a QMB who also meets the financial criteria for full Medicaid coverage. QMB Plus individuals are entitled to QMB Medical Benefits, plus all benefits available under the Texas State Plan for fully eligible Medicaid recipients.

QMB Plus means a QMB who also meets the financial criteria for full Medicaid coverage. QMB Plus individuals are entitled to QMB Medical Benefits, plus all benefits available under the Texas State Plan for fully eligible Medicaid recipients. Qualifying Individual (QI) means an individual who is entitled to Medicare Part A, meets federal income and resource criteria, and who is not otherwise eligible for Medicaid. A QI is eligible only for Medicaid payment of Medicare Part B premiums. Specified Low-income Medicare Beneficiary (SLMB) means in individual who is entitled to Medicare Part A and meets federal income and resource criteria. A SLMB is eligible for payment of Medicaid payment of Medicare Part B premiums. Categories of SLMBs are:

QMB Plus means a QMB who also meets the financial criteria for full Medicaid coverage. QMB Plus individuals are entitled to QMB Medical Benefits, plus all benefits available under the Texas State Plan for fully eligible Medicaid recipients. Specified Low-income Medicare Beneficiary (SLMB) means in individual who is entitled to Medicare Part A and meets federal income and resource criteria. A SLMB is eligible for payment of Medicaid payment of Medicare Part B premiums. Categories of SLMBs are:

Examples of QMB Plus in a sentence

• An individual who is entitled to Medicare, does not meet either QMB Plus or SMB Plus categorical income criteria, but is determined eligible for full AHCCCS benefits.

• CMS strictly prohibits Balance Billing QMB Plus (Qualified Medicare Beneficiary plus Full Medicaid) – Medicaid Status Code 02 Required – must bill Medicaid, no exceptions.

• Members For purposes of this Agreement, High Risk Dual Eligible Members are limited to the following categories of recipients: QMB Plus and SLMB Plus.

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

• This includes Qualified Medicare Beneficiaries with full Medicaid (QMB Plus) and Specified Low-Income Medicare Beneficiaries with full Medicaid (SLMB Plus) aged 65 or older and with MassHealth Standard coverage.

• For a QMB Plus 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.

• These individuals are considered to be Full Benefit Dual Eligible Members, and include Qualified Medicare Beneficiary Plus (QMB Plus), Specified Low-Income Medicare Beneficiary Plus (SLMB Plus) and Other Full Benefit Dual Eligible (Other FBDE) populations.

• This plan may enroll dual eligibles who are FBDE, SLMB Plus, QMB Plus and QMB.

• A QMB Plus 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.

• These “Medicare Savings Programs” help people with limited income and resources save money each year: • Qualified Medicare Beneficiary (QMB Plus): An individual who is a Full Benefit Dual Eligible Member entitled to Medicare, meets the Federal income standard of equal to or less than 100 percent of the Federal Poverty Level (FPL), and is determined eligible for full AHCCCS (Medicaid) benefits.

More Definitions of QMB Plus

QMB Plus is an individual who meets all of the Qualified Medicare Beneficiary (QMB) eligibility requirements and who also meets the criteria for full Medicaid benefits under New York’s Medicaid Plan.

QMB Plus means a QMB who also meets the financial criteria for full Medicaid coverage. QMB Plus individuals are entitled to QMB Medical Benefits, plus all benefits available under the Texas State Plan for fully eligible Medicaid recipients. Upon execution of this Agreement, the MA Dual SNP must provide HHSC with a copy of the MA Agreement and all attachments. The MA Dual SNP must provide HHSC with the actuarial value for Medicare Cost Sharing Obligations for the projection period consistent with the CMS bid submission. The MA Dual SNP agrees to provide HHSC a summary of its benefit designs for Dual Eligible Members and Other Dual SNP Members as well as financial data in a set format that allows HHSC, in HHSC’s sole determination, to determine the cost of services and utilization experience to calculate the PMPM rates. In addition, the MA Dual SNP must also provide all amendments to the MA Agreement or the Bid Pricing Tool to HHSC within fifteen (15) business days of receiving a request for this information.