Medicaid Coverage of Medicare Beneficiaries (Dual Eligibles) at a Glance - Part 2


Dual Eligible Medicare Beneficiary Groups

See the First part for better understanding.

Qualified Medicare  Beneficiary (QMB Only)

A QMB is an individual who:
 ■ is entitled to Medicare Part A;
 ■ has income that does not exceed 100 percent of the Federal Poverty Level (FPL); and
 ■ has resource that do not exceed three times the Supplemental Security Income (SSI) limit, adjusted annually for inflation.

A QMB is eligible for Medicaid payment of Medicare premium, deductible, coinsurance, and copayment amounts (except for Part D). A QMB who does not qualify
for any additional Medicaid benefits is called a “QMB Only.”

QMB Plus

A QMB Plus is an individual who:
 ■ meets all of the standards for QMB eligibility as described above;
 ■ meets the financial criteria for full Medicaid coverage; and
 ■ is entitled to all benefits available to a QMB, as well as all benefits available under the State Medicaid plan to a fully eligible Medicaid recipient.

These individuals often qualify for full Medicaid benefits by meeting the Medically Needy standards, or through spending down excess income to the Medically Needy level.

Specified  Low-Income  Medicare  Beneficiary (SLMB Only)

An SLMB is an individual who:
 ■ is entitled to Medicare Part A;
 ■ has income that exceeds 100 percent of the FPL, but less than 120 percent of the FPL; and
 ■ has resource that do not exceed three times the Supplemental Security Income (SSI) limit, adjusted annually for inflation.

The only Medicaid benefit for which an SLMB is eligible is payment of Medicare Part B premiums. An SLMB who does not qualify for any additional Medicaid benefits is
called an “SLMB Only.”

SLMB Plus
An SLMB Plus is an individual who:
 ■ meets the standards for SLMB eligibility;
 ■ meets the financial criteria for full Medicaid coverage; and
 ■ is entitled to payment of Medicare Part B premiums, as well as all benefits available under the State Medicaid plan to a fully eligibleMedicaid recipient.

These individuals often qualify for full Medicaid benefits by meeting the Medically Needy standards, or through spending down excess income to the Medically Needy
level.

Continued in next part

No comments:

Medical Billing Popular Articles