Resources
  • PAYING FOR HOSPICE

    Determining how to pay for hospice services is one of the first things that patients and their families consider. Below are answers to frequently asked questions about how to pay for hospice:

     

    Medicare Hospice Benefit

    The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of medical and support services for their life-limiting illness. Hospice care also supports the family and loved ones of the person through a variety of services. Eighty percent of people who use hospice care are over the age of 65 and are thus entitled to the services offered by the Medicare Hospice Benefit. This benefit covers virtually all aspects of hospice care with little out-of-pocket expense to the person or family.

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    Who is eligible for Medicare Hospice Benefits?

    You are eligible for Medicare hospice benefits when you meet all of the following conditions:

    • You are eligible for Medicare Part A (Hospital Insurance), and
    • Your doctor and the hospice medical director certify that you have a life-limiting illness and if the disease runs its normal course, death may be expected in six months or less, and
    • You sign a statement choosing hospice care instead of routine Medicare covered benefits for your illness*, and
    • You receive care from a Medicare-approved hospice program.

    *Medicare will still pay for covered benefits for any health needs that aren't related to your life-limiting illness.

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    What does Medicare cover?

    Medicare defines a set of hospice core services, which means that hospices are required to provide these set of services to each person they serve.

    Medicare covers these services related to a terminal diagnosis and ordered by the hospice team:

    • Nursing care
    • Doctor services
    • Medical equipment (e.g. wheelchairs, walkers, oxygen, hospital bed)
    • Medical supplies (e.g. bandages and catheters)
    • Drugs for symptom control and pain relief
    • Short-term care, including inpatient and respite care for pain and symptom management, caregiver relief
    • Home health aide and homemaker services
    • Physical and occupational therapy
    • Speech therapy
    • Social work services
    • Dietary counseling
    • Grief support to help you and your family

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    What does Medicare NOT cover?

    Treatment intended to cure your illness.

    You will receive comfort care to help manage symptoms related to your illness. Comfort care includes medications for symptom control and pain relief, physical care, counseling, and other hospice services.

    Medications not directly related to your hospice diagnosis are not covered under the Medicare Hospice Benefit.

    Hospice team members will consult with the hospice physician and will inform you and your family which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit. The Hospice uses medicine, equipment, and supplies to make you as comfortable as possible. Under the hospice benefit, Medicare won't pay for treatment where the goal is to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. You always have the right to stop getting hospice care and receive the "traditional" Medicare coverage you had before electing hospice.

    Care from another provider that is the same care that you are getting from your hospice.

    All care that you receive for your illness must be given by your hospice team. You can't get the same type of care from a different provider unless you change your hospice provider.

    Nursing Home Room and Board

    Room and board aren't covered by Medicare. You may receive hospice services wherever you live, even in a nursing home, however, the Medicare Hospice Benefit does not pay for nursing home room and board.

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    How is Hospice paid for?

    Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers.

    Medicaid benefits vary by state and private insurances offer a wide variety of coverage. Our expert financial staff can help you understand your coverage provisions and will contact Medicaid or your insurance company to determine your specific benefits.

    What to Expect After Choosing a Hospice Agency

    A nurse will come to your home to do an assessment and ask questions about your medical history. From this information a plan of care will be developed with you and your physician. The plan of care will include the services you will receive, how often, and your goals.

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    It's Your Choice

    You can choose to receive services from any Medicare-certified agency. Your doctor and/or case manager should respect your decision. If you are unhappy with the agency you have been working with, you can change at any time. You need to let both the new and old agency know of your decision.

    Find Out About the Hospice Agencies in Your Area By:

    • Talking to your doctor
    • Accessing community resources like the 55+ book arranged by Aging Services
    • Looking in the phone book under "Hospice"
    • Going to health fairs and community sponsored events

    Your Rights

    • To choose your agency
    • To be told when Medicare will not cover a service (verbally and in writing)
    • To receive the services your doctor orders
    • To be involved in planning care and discharges
    • You cannot be denied services due to your condition unless the agency denies everyone with your condition

    If you would like more information on this subject; please contact us or go to www.medicare.gov, search publications for "Hospice", or call 1-800-MEDICARE (1-800-633-4227).

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Nondiscrimination Policy
It is our policy to offer these services to all qualified patients without discrimination in compliance with state and federal regulations.