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The Hospice Benefit is designed to meet
the unique needs of those who have a terminal illness, providing
them and their loved ones with special support and services not
otherwise covered by Medicare, Medicaid, or insurance. Under the
Hospice Benefit, beneficiaries elect to receive non-curative
treatment and services for their terminal illness by waiving the
standard benefits for treatment of a terminal illness. However,
the beneficiary may continue to access standard benefits for
treatment of conditions unrelated to the terminal illness. For
more information about Medicare health plans or to receive a
Medicare handbook, call 1-800-MEDICARE (1-800-633-4227). For
information about Medicaid plans, contact your state Medicaid
office. For insurance questions, contact your insurance provider.
Who is eligible for hospice care?
Hospice care is available for
patients who:
-
Are certified by their doctor and the hospice medical director
as terminally ill and have a life expectancy of six months or
less;
-
Elect to receive hospice care, rather than curative treatment
for their terminal illness; and
-
Enroll in a hospice program which is approved by Medicare,
Medicaid, or their insurance plan
What
services are usually covered under the Medicare, Medicaid, or
insurance hospice benefit?
The
hospice benefit covers the following services as long as they
relate to the terminal diagnosis and are outlined in the patient's
care plan:
- Physician services
for the medical direction of the patient's care, provided by
either the patient's personal physician or a physician
affiliated with a hospice program;
- Regular home care
visits by registered nurses and licensed practical nurses to
monitor the patient's condition and to provide appropriate care
and maintain patient comfort;
- Home health aide and
homemaker services such as dressing and bathing that address the
patient's personal needs;
- Chaplain services for
the patient and/or loved ones, if desired;
- Social work and
counseling services;
- Bereavement
counseling to help patients and their loved ones with grief and
loss;
- Medical equipment
(i.e., hospital beds);
- Medical supplies
(i.e., bandages and catheters);
- Drugs for symptom
control and pain relief;
- Volunteer support to
assist the patient and loved ones;
- Physical, speech, and
occupational therapy; and
- Dietary counseling.
Can
hospice care be provided in a place other than a personal
residence?
Sometimes
a patient does not or cannot reside in a private home. The
Medicare, Medicaid, or insurance Hospice Benefit reimburses for
hospice services that are delivered in freestanding hospice
facilities, hospitals, and nursing homes and other long-term care
facilities. However, the Benefit does not cover expenses for room
and board. In some instances, Medicaid may cover these expenses
for eligible patients. For details about benefits available under
Medicaid, consult your state Medicaid office.
Does the
hospice benefit cover continuous care (a special level of hospice
care) at home?
Yes. If
there is a brief, acute episode that requires additional care to
manage pain or acute medical symptoms, nursing care may be covered
on a continuous basis to maintain the patient at home. Skilled
nursing or home health aide services, or a combination of both may
be covered on a 24-hour basis during periods of crisis, but care
during these periods must be predominantly nursing care.
Does the
hospice benefit cover general inpatient care that may be needed as
a result of a crisis or an acute episode that cannot be handled in
a patient's primary residence?
Yes, if a
hospice inpatient admission is necessary for the patient, the
hospice team will arrange for the patient's stay in a freestanding
hospice facility, a hospital, a nursing home, or other long-term
care facility.
Is there
any relief for loved ones whose responsibility it is to care for
the hospice patient?
Caregivers (family members or other loved ones responsible for
taking care of the hospice patient,) may, on occasion, need a
break, or respite, from daily caregiving. To give the caregiver
relief, respite care may be provided for up to five days in an
approved facility such as a freestanding hospice facility, a
hospital, a nursing home or other long-term care facility.
What is
not covered?
The
following services are not covered under the Medicare, Medicaid,
or insurance Hospice Benefit:
- Services for
conditions unrelated to the terminal illness, or
- Services for the
terminal diagnosis that are not called for in the hospice care
plan or arranged for by the hospice program.
Care that
patients receive under the hospice benefit for their terminal
illness must be from an approved hospice program.
Is a
patient's Medicare, Medicaid, or insurance coverage forfeited if
hospice care is chosen?
Not at
all. A patient retains full coverage for any health care needs not
related to the terminal diagnosis, even if the patient elects
hospice care. The patient must continue to pay the applicable
deductible and coinsurance amounts under their Plan.
How long
can a patient receive hospice care?
Patients can receive hospice care for as long as the physicians
continue to recertify the terminal illness.
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