Medicare Hospice Benefits
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Medicare changes quite frequently so this is here only to let you know that some Hospice services are covered by Medicare. If you want more information about it, please check with the Social Security Office or state Health Services to see what has been revised!
Hospice care is a special way of caring for a patient whose disease cannot be cured. It is available as a benefit under Medicare Hospital Insurance (Part A). Medicare beneficiaries who choose hospice care receive non-curative medical and support services for their terminal illness.
To be eligible, they must be certified by a physician to be terminally ill with a life expectancy of six months or less. While they no longer receive treatment toward a cure, they require close medical and supportive care which a hospice can provide. Hospice care under Medicare includes both home care and inpatient care, when needed, and a variety of services not otherwise covered by Medicare. The focus is on care, not cure. Emphasis is on helping the person to make the most of each hour and each day of remaining life by providing comfort and relief from pain.
This document explains
the special rules that govern Medicare coverage of, and payment for, hospice
What is hospice care?
Under Medicare, hospice is primarily a program of care delivered in a person's home by a Medicare - approved hospice. Reasonable and necessary medical and support services for the management of a terminal illness are furnished under a plan-of-care established by the beneficiary's attending physician and the hospice team.
Who is eligible?
Hospice care is available under Medicare only if:
Who can provide hospice care?
Hospice care can be provided by an agency or organization that is primarily engaged in furnishing services to terminally ill individuals and their families. To receive Medicare payment, the agency or organization must be approved by Medicare to provide hospice services.
Approval for hospice is required even if the agency or organization is already approved by Medicare to provide other kinds of health services. Patients can find out whether a hospice program is approved by Medicare by asking their physician or checking with the agency or organization offering the program. This information also is available from local Social Security offices.
Hospice uses a team approach
that includes the patient and family, nurses, social workers, physicians,
clergy and volunteers, all working together to plan and coordinate care.
Family or friends (serving as primary caregivers) in the home can call
for the help of a hospice team member 24 hours a day, 7 days a week. The
team member will come to the patient's home whenever needed and appropriate.
The hospice team can arrange for a transfer to another setting when necessary.
How long can hospice care continue?
Special benefit periods apply to hospice care. A Medicare beneficiary may elect to receive hospice care for two 90-day periods, followed by an unlimited number of 60-day periods. The benefits periods may be used consecutively or at intervals. Regardless of whether they are used one right after the other or at different times, the patient must be certified as terminally ill at the beginning of each period.
A patient who chooses
hospice care may change hospice programs once each benefit period. A patient
also has the right to cancel hospice care at any time and return to standard
Medicare coverage, then later re-elect the hospice benefit in the next
benefit period. If a patient cancels during one of the first three benefit
periods, any days left in that period are lost.
How is payment made?
Medicare pays the hospice directly at specified rates depending on the type of care given each day. The patient is responsible only for:
Are other Medicare benefits available?
When Medicare beneficiaries
choose hospice care, they give up the right to standard Medicare benefits
only for treatment of the terminal illness. If the patient, who must have
Part A in order to use the Medicare hospice benefit, also has Medicare
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 terminal illness.
When standard benefits are used, the patient is responsible for Medicare's
deductible and coinsurance amounts.
What is not covered?
All services required for treatment of the terminal illness must be provided by or through the hospice. When a Medicare beneficiary chooses hospice care, Medicare will not pay for:
To determine whether a Medicare-approved hospice program is available in your area, contact the nearest Social Security Administration office, your state or local health department, your state hospice organization, or call the National Hospice Organization Hospice Information Line (800) 658-8898.
excerpted from the Medicare Hospice Benefit a publication of: U.S. Department
of Health and Human Services, Health Care Financing Administration.
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