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Home > Insurance Coverage > Medicare Frequently Asked Questions
Frequently Asked Questions about Medicare Hospice Benefits
What is the Medicare Hospice Benefit?
Hospice care is available as a benefit under Medicare Part A. The Medicare Hospice Benefit is designed to serve patients who have a terminal illness. It provides support and services not generally covered by Medicare. Under the Medicare Hospice Benefit, beneficiaries waive the right to receive curative treatment and elect to initiate palliative care and services for their terminal illness. These services have been developed under Medicare guidelines to provide pain management and emotional support during the end of life process. The focus is on care, not cure. Emphasis is on helping the person to make the most of each day that remains to them by providing comfort and relief from pain. However, the beneficiary may continue to receive standard Medicare benefits for treatment of conditions unrelated to the terminal illness. For more information about Medicare hospice benefits, call 1-800-MEDICARE (1-800-633-4227).
What services does Medicare's Hospice Benefit cover?
- Physicians' services (provided by either the patient's personal physician or a physician affiliated with a hospice program) Regular home care visits by RNs and LPNs to monitor the patient's condition, provide appropriate care and maintain patient comfort (scheduled at prearranged intervals with 24-hour on call support) Medical appliances and supplies related to the terminal illness (hospital beds, geri chairs, bandages, catheters, etc.) Outpatient drugs for symptom management and pain relief Short-term acute inpatient care (or respite care)Home health aide and homemaker services (dressing, bathing, personal care and light housekeeping that address the patient's personal needs) Physical therapy, occupational therapy and speech/language pathology services Medical social services, and counseling, including dietary, spiritual and bereavement counseling \ Chaplain services for the patient and family members
- Volunteer support to assist the patient and loved ones
NOTE: Coverage is subject to the terminal diagnosis and must be outlined in the patient's care plan
How do I qualify for Medicare hospice benefits?
- You must be certified by your doctor and the hospice medical director as terminally ill and have a life expectancy of six months or less You must sign a statement choosing hospice care using the Medicare Hospice Benefit, rather than curative treatment (this means you choose to give up benefits relating to curing your terminal disease, though you may still receive Medicare benefits for treatment of problems not related to your terminal illness)
- You must be enrolled in a Medicare-approved hospice program.
What if I have an acute medical problem while on hospice at home?
If you should have a short medical emergency that requires continuous nursing care to manage pain or acute medical symptoms, it may be covered in order to maintain the patient at home. Skilled nursing or home health aide services may be used, but care during these periods must mainly come from registered nurses.
What if I have to go to the hospital, during hospice care at home?
If admission is necessary, the hospice team will arrange for the patient to stay in a contracted inpatient hospice facility, a hospital, or a nursing home. This would be covered by Medicare. Your hospice nurse will continue to visit you while you are in the hospital.
What if I'm not living at home?
Medicare reimburses for hospice services that are delivered in inpatient hospice facilities, hospitals, and nursing homes and other long-term care facilities. This does not include room and board. In some instances, Medicaid may cover these expenses for eligible patients. Your state Medicaid office can tell you if you qualify.
What is respite care and is it covered?
Sometimes family members who are caregivers, or other loved ones responsible for taking care of the hospice patient need a break, or respite, from daily care giving. This can be covered if provided in a Medicare-approved facility. Medicare will cover these stays for up to five days at a time.
What services are not covered?
- Services for conditions unrelated to the terminal illness
- Services for the terminal diagnosis that are not called for in the hospice care plan or arranged for by the hospice program Care given by another healthcare provider that was not arranged for by the patient's hospice care provider
- Care from another provider which duplicates care the hospice is required to provide
Remember, to qualify for the Medicare Hospice Benefit care must be provided by a Medicare-approved hospice program.
What costs are covered and what expenses must I pay?
- Medicare pays the hospice directly for the patient's hospice care
- Patients may have to pay no more than 5 percent (up to $5 for each prescription) for drugs for pain relief and symptom control
- Patients or their families may also be responsible for 5 percent of the Medicare payment amount for inpatient respite care.
What happens if I decide to go off hospice?
If the patient has Medicare or Medicaid, their hospice benefit reverts to their traditional health care benefit.
How long can I receive hospice care?
Hospice care was designed for terminally ill patients who have been certified by their doctor as having a life expectancy of six months or less.
Patients who live beyond six months may be recertified by their physician to remain on hospice, if it can be shown that they are still considered to be terminally ill, and in the normal course of events, would have a life expectancy of six months or less.
What if I am enrolled in a Medicare managed care (HMO) plan?
A hospice-eligible patient who is enrolled in a Medicare managed care plan may choose any Medicare-certified hospice provider. The same hospice benefits apply, whether the patient has traditional medicare, or is enrolled in a medicare HMO.
What if I am unhappy with my hospice provider?
The patient has the right to transfer to a different hospice provider without a lapse in coverage.
Where can I find a listing of Medicare-certified hospice programs?
- National Hospice and Palliative Care Database
- State Hospice Associations State Health Departments Health Care Professionals
- Clergy
- Social Workers
Choose the Missouri AmHeart Hospice Location nearest you:
St. Louis - Troy - Farmington