Full Benefit Dual Eligible (FBDE) definition
Full Benefit Dual Eligible (FBDE). Means an individual who is eligible for all Medicaid benefits under the State Medicaid Plan because the individuals falls within a federal mandatory coverage group or an optional coverage group (such as medically needy) but who does not meet the income or resource criteria for QMB or SLMB. Under the State Medicaid plan, FBDEs are eligible for some financial assistance from the Agency in connection with Medicare Part A premiums, and in some cases Medicaid Part B premiums. Medicare Cost-Sharing Obligations may effectively be covered by state Medicaid benefit, but certain conditions must be met, including 1) the service is also covered under Medicaid, 2) the provider is also a Medicaid provider, and 3) the Medicaid fee schedule amount is greater than the Medicare amount paid.”
Examples of Full Benefit Dual Eligible (FBDE) in a sentence
Contractor shall actively support Full Benefit Dual Eligible (FBDE) Member enrollment decisions by providing information about opportunities to align and coordinate Medicaid benefits with Contractor’s Affiliated or Contracted Medicare Advantage or Dual Special Needs Plan.
Other Full Benefit Dual Eligible (FBDE): An individual who does not meet the income and/or resource criteria for QMB or SLMB, but is eligible for Categorically Needy (CN) Medicaid or Medically Needy (MN) through coverage groups based on MN spenddown status, special income levels for institutionalized individuals, home and community-based waivers, or those with blindness or disability who are working and enrolled in Apple Health for Workers with Disabilities.