Coordination Of Dual Eligible Services: July 2015

The correct answer explains that the individual has Medicare coverage as their primary insurance. However, they are also enrolled with Sunshine Health, which provides coverage for long-term care and medical services that are not covered by Medicare. Additionally, the individual is covered under a 'Qualified Medicare Beneficiary' program, which helps pay for premiums, deductibles, and coinsurance under Medicare.

The plan is ending on 7/31/2015 because the recipient lost full Medicaid coverage (MII) and now only has QMB. QMB is limited coverage that helps pay for Medicare premiums, deductibles, and coinsurance. Recipients with QMB only cannot enroll, so the current plan cannot continue for the recipient.

The correct answer explains that the recipient has a limited type of Medicaid called "Qualified Medicare Beneficiary" which helps pay for some of their Medicare costs. It also states that Medicare is their primary insurance and advises them to contact Medicare to find out how they can receive services. This response provides specific information about the recipient's Medicaid coverage and directs them to the appropriate authority for further assistance.

Medicare Part D covers prescription drugs. This means that it helps individuals pay for their necessary medications, reducing the out-of-pocket costs associated with prescription drugs. Inpatient hospital stays, preventive services, and doctor's visits are typically covered under other parts of Medicare, such as Part A and Part B. However, Medicare Part D specifically focuses on providing coverage for prescription medications.

Flora should be advised that Medicare is her primary insurance and she has limited Medicaid coverage that picks up some of the out of pocket expenses from Medicare. This means that Flora cannot choose a plan, as her Medicaid type does not allow her to enroll in one. However, she should be informed about her current health coverage situation and the role of Medicaid in covering some of her expenses.

Medicare Part C, also known as a Medicare Advantage Plan, provides coverage for both Medicare Part A and Part B insurance benefits. This means that individuals who enroll in Medicare Part C will have access to hospital insurance (Part A) as well as medical insurance (Part B) which covers doctor visits, outpatient care, and other medical services. This option combines the benefits of both parts of Medicare into one comprehensive plan.

Barbara should be advised to contact Better Health because the MMA plan will help coordinate services between Medicare and Better Health. This means that Better Health will work together with Medicare to ensure that Barbara's inpatient stay for her surgery is covered. By contacting Better Health, Barbara can get the necessary information and assistance regarding the coverage of her services.

The QMB Program allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance. This means that individuals who qualify for the program will have their healthcare costs covered by Medicaid, reducing their out-of-pocket expenses for Medicare services. This can be particularly beneficial for low-income individuals who may struggle to afford these costs on their own.

The SLMB Program allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums. This means that individuals who meet the eligibility criteria can have their Medicaid coverage cover the cost of their Medicare Part B premiums, which helps to reduce their out-of-pocket expenses. This program is designed to provide financial assistance to individuals who may not be able to afford the Medicare Part B premiums on their own.

The statement "All QMB recipients are excluded for enrollment" is false. This means that QMB recipients are not excluded from enrolling in something.

Based on the given information, the recipient would be excluded from MMA eligibility.

The correct answer is that the member should contact the MMA plan's case manager. This is because the MMA plan is responsible for coordinating the member's care with Medicare and ensuring that the MMA plan does not authorize or provide duplicative services. By contacting the case manager, the member can get accurate information about who will cover their services and avoid any confusion or duplication of services.

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A Medicare beneficiary who qualifies to receive all Medicaid services is called a Full Benefit Dual Eligible. This term refers to individuals who are eligible for both Medicare and Medicaid and are entitled to receive the full range of benefits from both programs. They typically have low incomes and may also have certain disabilities or chronic conditions that qualify them for Medicaid coverage. As Full Benefit Dual Eligibles, these individuals have access to comprehensive healthcare coverage and may receive assistance with medical expenses that are not covered by Medicare alone.

The statement is false because QMB coverage does not cover services using straight Medicaid. QMB (Qualified Medicare Beneficiary) coverage is a Medicaid program that helps pay for Medicare premiums, deductibles, copayments, and coinsurance for individuals who are eligible for both Medicare and Medicaid. However, it does not provide coverage for services that are solely covered by straight Medicaid.