Appendix A
A HIGHLIGHTS OF MEDICARE HOSPICE COVERAGE

ELIGIBILITY

  • Hospice care is covered under Medicare Part A for terminally ill patients when: patients are eligible, have a physician certification, have chosen hospice care and care is given by a Medicare approved hospice program.
  • Hospice care is covered under Medicare Part A (Hospital Insurance). Beneficiaries are eligible for Medicare hospice benefits if:
    • Eligible for Medicare Part A (Hospital Insurance);
    • Doctor (attending physician) and the hospice medical director certify that you are terminally ill and have less than six months to live;
    • Receive care from a Medicare-approved hospice program.
    • Beneficiary signs a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness. The revocation of Medicare coverage applies only to palliative care services for the terminal condition; therefore, any services that are not related to the terminal illness should continue to be billed as usual.

LENGTH OF CARE

  • Hospice care is available for two (2) periods of ninety (90) days and an unlimited number of sixty (60) day periods. The beneficiary can terminate their enrollment during a hospice period without a delay or lapse in Medicare coverage. If they terminate their enrollment during a hospice period, they do lose hospice coverage for the remaining days in the period. However, they can re-enroll in the hospice program again without losing hospice care days. Any change in enrollment is effective immediately.
  • Medicare Covered Services – Medicare covers services such as doctor and nursing care, certain medical equipment and supplies, certain drugs for pain or symptoms, home health aide services, therapy, social work and counseling (including family), and short term inpatient stays.

WHAT IS COVERED?

  • Physician services
  • Nursing care
  • Medical equipment (such as wheelchairs or walkers)
  • Medical supplies (such as bandages and catheters)
  • Drugs for symptom control and pain relief
  • Short-term care in the hospital, including respite care (see below)
  • Home health aide and homemaker services
  • Physical and occupational therapy
  • Speech therapy
  • Social worker services
  • Dietary counseling
  • Counseling to help you and your family with grief and loss

Beneficiaries will only have to pay a small co-payment for medications and inpatient respite care. When you choose hospice care, Medicare will not pay:

  • Treatment to cure your terminal illness. As a hospice patient, you can get comfort care to help you cope with your illness, not cure it. Comfort care includes drugs for symptom control and pain relief, physical care, counseling, and other hospice services. Hospice uses medicine, equipment, and supplies to make you as comfortable and pain-free as possible. Medicare will not pay for treatment to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. As a hospice patient, you always have the right to stop getting hospice care and go back to your regular doctor or health plan.
  • Care from another hospice that was not set up by the elected hospice. The beneficiary must get hospice care from the hospice provider chosen. The beneficiary cannot get hospice care from another hospice provider, unless he/she changes the hospice provider.
  • Care from another provider that is the same care that you must get from your hospice. All care for the beneficiary's terminal illness must be given by the chosen hospice team. The beneficiary cannot get the same type of care from a different provider unless he/she changes the hospice provider.

Respite Care:

  • Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. As a hospice patient, you may have one person that takes care of you every day. That person might be a family member or a friend. Sometimes they need someone to take care of you for a short time while they do other things that need to be done. During a period of respite care, you will be cared for in a Medicare-approved facility, such as a hospice facility, hospital or nursing home.

Physician Certification:

  • The hospice benefit is intended primarily for use with patients whose prognosis is terminal, with six months or less of life expectancy. The Medicare program recognizes that terminal illnesses do not have entirely predictable courses, therefore, the benefit is available for periods of time beyond six months provided the proper certification is made at the start of each benefit period. Please see additional instructions regarding physician certification in Program Memorandum AB-01-09.

For further information regarding Medicare Hospice Benefits see:
http://www.medicare.gov/Publications/Pubs/pdf/02154.pdf (pdf format 114Kb)

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