Medicare/Medicaid
The Medicare Hospice Benefit
The Medicare program consists primarily of two parts - Part A (described as Hospital Insurance) and Part B (Supplementary Medical Insurance). Hospice care is available as a benefit under Medicare Part A. The Medical Hospice Benefit is designed to meet the needs of those who are terminally ill, providing them with special support and services not otherwise covered by Medicare.
Who is eligible for the Hospice Medicare Benefit and how is it obtained?
Medicare coverage for hospice care is available to patients eligible for Medicare Part A. The patient must sign a statement choosing hospice care for the life-limiting illness. The hospice care must be from a Medicare-approved hospice program. The patient's physician or hospice physician must certify that the patient has an illness with a life expectancy of six months or less.
What is covered under the Hospice Medicare Benefit?
Hospice care is a unique individualized plan of care tailored to patient and family needs. When a Medicare-eligible patient receives services from a Medicare-approved hospice, Medicare pays the entire cost. The Medicare Hospice Benefit covers the following services as long as they relate to the life-limiting diagnosis and are outlined in the patient's plan of care:
- Physicians' services
- Nursing care by registered nurses and licensed practical nurses
- Medical supplies and equipment related to the life-limiting illness
- Prescriptions related to the life-limiting illness for symptom management and pain control
- Respite care to provide rest and comfort to the family or caregivers
- Medical social services
- Home health aide
- Physical and occupational therapy
- Speech/language pathology services
- Dietary counseling
- Chaplain/spiritual counseling
- Grief and bereavement services for 13 months after the patient's death
- Volunteer services
What help is provided to the family?
Education and counseling for family members is covered. Volunteers are available as needed to provide services and to make the caregiver's role easier. Home health aides assist with the patient's personal needs. Bereavement care is available to the immediate and extended family.
How long may a patient continue to receive hospice care under Medicare?
The Hospice Medicare benefit is structured in benefit periods. The first two periods are for 90 days each, followed by an unlimited number of subsequent periods of 60 days each. The hospice benefit may be revoked at any time during a benefit period. The patient may then return to regular Medicare benefits under Part A and B. Plus, you may later at any time re-elect the hospice Medicare benefit.
Will Medicare pay for hospice in a place other than a personal residence?
The Medicare Benefit provides hospice services that are delivered in hospitals, nursing homes, assisted living and other long-term care facilities. However, it does not cover expenses for room and board. In some cases, Medicaid will cover theses expenses for eligible individuals.
May other Medicare services be received while on the Medicare hospice benefit?
Even though the hospice team includes a physician, patients can continue to use their personal physician. Medicare will help pay for covered services provided by a physician not affiliated with the hospice if the patient is covered by Medicare Medical Insurance (Part B). Also, if the patient has Part B, he or she can use all appropriate Medicare Part A and Part B benefits for the treatment of health problems unrelated to the life-limiting illness. When standard benefits are used, the patient is responsible for Medicare's deductible and coinsurance amounts. Legacy Hospice is not responsible for treatments unrelated to the life-limiting diagnosis or treatments that are not palliative in nature. Click here for more information from Medicare: Medicare Hospice Benefits