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Medicare Coverage of Hospice & Respite Services

 

Hospice care is usually given in your home, but it also may be covered in a hospice inpatient facility. Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services:  

  • Doctor services
  • Nursing care including nurse practitioners
  • Medical equipment (like wheelchairs or walkers)
  • Medical supplies (like bandages and catheters)
  • Prescription drugs for symptom control or pain relief
  • Hospice aides and homemaker services
  • Physical and occupational therapy
  • Speech-language pathology services
  • Social work services and counselors
  • Pharmacists
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term inpatient care (for pain and symptom management)
  • Short term respite care
  • Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team
  • Volunteers 

When you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren't working.

Who’s eligible for the hospice benefit if you have Medicare Part A (Hospital Insurance) AND meet all of these conditions, you can get hospice care: 

  • Your hospice doctor and your regular doctor or nurse practitioner (if you have one) certify that you’re terminally ill (you’re expected to live 6 months or less). 
  • You accept palliative care (for comfort) instead of care to cure your illness. 
  • You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions. 

Note: Only your hospice doctor and your regular doctor or nurse practitioner (if you have one) can certify that you’re terminally ill and have 6 months or less to live. 

You can get hospice care if you have Medicare Part A (Hospital Insurance) meet all of these conditions:

  • Your hospice doctor and your regular doctor or nurse practitioner (if you have one) certify that you’re terminally ill (you're expected to live 6 months or less).
  • You accept palliative care (for comfort) instead of care to cure your illness.
  • You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

Only your hospice doctor and your regular doctor or nurse practitioner (if you have one) can certify that you’re terminally ill and have a life expectancy of 6 months or less.

You can get a one-time only hospice consultation with a hospice medical director or hospice doctor to discuss your care options and management of your pain and symptoms. You can get this one-time consultation even if you decide not to get hospice care. Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness, but the care you get must be from a Medicare-approved hospice provider. Hospice care is usually given in your home, but it also may be covered in a hospice inpatient facility. Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services: 

Hospice is a program of care and support for people who are terminally ill. Here are 7 important facts about hospice: 

  • Hospice helps people who are terminally ill live comfortably.
  • Hospice isn’t only for people with cancer. 
  • The focus of Hospice is on comfort, not on curing an illness. 
  • A specially trained team of professionals and caregivers provide care for the “whole person,” including physical, emotional, social, and spiritual needs. 
  • Services typically include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions. 
  • Care is generally provided in the home. 
  • Family caregivers can get support. 

In addition, a hospice nurse and doctor are on-call 24 hours a day, 7 days a week to give you and your family support and care when you need it. A hospice doctor is part of your medical team. You can also choose to include your regular doctor or a nurse practitioner on your medical team, as the attending medical professional who supervises your care. The hospice benefit allows you and your family to stay together in the comfort of your home, unless you need care in an inpatient facility. If your hospice provider determines that you need inpatient hospice care, your hospice provider will make the arrangements for your stay. 

Medicare won’t cover any of these once your hospice benefit starts:

  • Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you're thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
  • Prescription drugs to cure your illness (rather than for symptom control or pain relief).
  • Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you've chosen him or her to be the attending medical professional who helps supervise your hospice care.
  • Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
  • Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.  Note:Contact your hospice team before you get any of these services, or you might have to pay the entire cost. 

Your costs in Original Medicare

  • $0 for hospice care.
  • You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you're at home. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it's covered under Part D.
  • You may need to pay 5% of the Medicare-approved amount for inpatient  HYPERLINK "https://www.medicare.gov/coverage/hospice-and-respite-care.html#1418" \o "Temporary care provided in a nursing home, hospice inpatient facility, or hospital so that a family member or friend who is the patient's caregiver can rest or take some time off." respite care.
  • Medicare doesn't cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).

Once you start getting hospice care, your hospice benefit should cover everything you need related to your terminal illness, even if you remain in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan. After your hospice benefit starts, you can still get covered services for conditions not related to your terminal illness. Original Medicare will pay for covered services for any health problems that aren’t part of your terminal illness and related conditions. However, you must pay the deductible and coinsurance amounts for all Medicare-covered services you get to treat health problems that aren’t part of your terminal illness and related conditions. A Medigap Plan or Medicare Supplement Plan helps pay for the coverage gaps in original Medicare Part A and Part B.

If you qualify for hospice care, you and your family will work with your hospice provider to set up a plan of care that meets your needs. For more specific information on a hospice plan of care, call your national or state hospice organization. 

To find a hospice provider, talk to your doctor, or call your state hospice organization. Visit Medicare.gov/contacts, or call 1-800-MEDICARE (1-800-633-4227) to find the number for your state hospice organization. TTY users can call 1-877-486-2048. Medicare only covers your hospice care if the hospice provider is Medicare approved. To find out if a certain hospice provider is Medicare approved, ask your doctor, the hospice provider, your state hospice organization, or your state health department. If you belong to a Medicare Advantage Plan (like an HMO or PPO) and want to start hospice care, ask your plan to help you find a hospice provider in your area. Your plan must help you locate a Medicare-approved hospice provider in your area. 

Respite care 

If your usual caregiver (like a family member) needs rest, you can get inpatient respite care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home). Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but only on an occasional basis

What your hospice benefit won’t cover when you start hospice care, you’ve decided that you no longer want care to cure your terminal illness and related conditions, and/or your doctor has determined that efforts to cure your illness aren’t working. 

Medicare won’t cover any of these once your hospice benefit starts: 

  • Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you’re thinking about getting treatment to cure your illness. You always have the right to stop hospice care at any time. 
  • Prescription drugs (except for symptom control or pain relief). 
  • Care from any provider that wasn’t set up by the hospice medical team. 

You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness and related conditions must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care. 

If you have a Medigap policy, it will cover your hospice costs for drugs and respite care. Your Medigap policy also will help cover health care costs for problems that aren’t part of your terminal illness and related conditions. Call your Medigap policy for more information. 

How long you can get hospice care Hospice care is for people with a life expectancy of 6 months or less (if the illness runs its normal course). If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill. Important: Hospice care is given in benefit periods. You can get hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. At the start of the first 90-day benefit period, your hospice doctor and your regular doctor or nurse practitioner (if you have one) must certify that you’re terminally ill (with a life expectancy of 6 months or less). At the start of each benefit period after the first 90-day benefit period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill, so you can continue to get hospice care. A benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60-day benefit period ends. 

The right to change your hospice provider

You have the right to change your hospice provider once during each benefit period. Stopping hospice care if your health improves or your illness goes into remission, you may no longer need hospice care. You always have the right to stop hospice care at any time. If you choose to stop hospice care, you’ll be asked to sign a form that includes the date your care will end. You shouldn’t be asked to sign any forms about stopping your hospice care at the time you start hospice. Stopping hospice care is a choice only you can make, and you shouldn’t sign or date any forms until the actual date that you want your hospice care to stop.

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