Medicare Hospice Benefit
Paying for Hospice Care is typically covered by the Medicare Hospice Benefit and most private insurance companies. We never turn patients away due to an inability to pay.
Since 1983, the Medicare Hospice Benefit has enabled millions to receive end of life care that provides comfort, compassion, and dignity.
Under the Medicare Hospice Benefit, beneficiaries elect to receive pain and symptom management for their hospice diagnosis by waiving the standard Medicare benefits for treatment of an illness. The beneficiary, however, may continue to receive the Medicare benefit for treatment for other conditions unrelated to the Hospice diagnosis.
Hospice Benefits are available to Medicare beneficiaries who:
- Are certified by a physician as having a life-limiting diagnosis,
- sign a statement choosing Hospice Care using the Medicare Hospice Benefit, and
- enroll in a Medicare-certified Hospice program.
The Medicare Hospice Benefit covers the following services as they relate to the hospice diagnosis:
- Physician services for medical oversight of the patient’s care.
- Home care visits by registered nurses to monitor the patient’s condition and care.
- Home health aide visits to assist with dressing, bathing, and personal needs.
- Spiritual support for the patient, if desired.
- Social work or counseling services.
- Medical equipment.
- Medical supplies.
- Medications for symptom control and pain management.
- Volunteer support.
- Dietary counseling.
- Bereavement counseling and support services.
The Benefit provides hospice services delivered in hospice facilities, hospitals, long-term care facilities, and inpatient hospice units. However, the Benefit does not pay for room and board. In some instances, Medicaid will cover these expenses.
Hospice Care can be provided as long as the patient is certified as having a six month or less life expectancy. A patient can be re-certified for additional 60 and 90 day periods following the initial six months or less diagnosis. The Medicare Hospice Benefit is an unlimited benefit.
A patient has the right to change to another Hospice at any point, as long as the new Hospice is Medicare-approved.
Services for conditions unrelated to the Hospice diagnosis and services for the hospice diagnosis that are not addressed on the hospice plan of care arranged by the hospice provider.
Medicare pays Hospice directly for a patient’s care. Patients can be billed up to five percent for outpatient drugs for pain management and symptom control. The patient may also be responsible for five percent of the Medicare payment amount for respite care if the service is used. Patients are also responsible for room and board at facilities, if necessary.
A patient can stop receiving Hospice Care at any time, for any reason. If a person stops Hospice Care, the standard Medicare Benefits are restored. Sometimes a disease may go into remission while receiving Hospice Care. A person’s condition may also change such that the patient no longer has a six month or less life expectancy. And, a patient may decide they may want curative treatment once again. At any point, a patient may return to hospice care as long as the eligibility criteria are met and certification by a physician is received.