Medicare & Medicaid:
- These organizations pay a set amount for each day the patient is in hospice.
- This daily rate is expected to cover all services related to the terminal illness, regardless of the costs incurred.
- For more information concerning Hospice Benefit under Medicare, see below.
- Many insurance plans have hospice benefits.
- Care provided by hospice must be authorized by the insurance company.
- Some insurance companies pay separately for medications, equipment, laboratory tests and medical treatments.
- Some insurance companies pay for a set number of visits provided by hospice team members.
- Patients are responsible for their yearly deductible and co-pays, unless specified otherwise.
- For those who do not have medical insurance, Hospice has a sliding scale to assess Hospice charges.
- The sliding scale is based on financial ability to pay as set forth by Federal Poverty Guidelines approved by the Hospice of the Plains Board of Directors.
- For more information concerning this sliding scale, contact Hospice of the Plains.
Hospice Benefit Under Medicare:
Hospice care is available as a benefit under Medicare Hospital Insurance (Part A) for those seeking non-curative medical and support services during their terminal illness. Hospice care under Medicare includes both home care and inpatient care, when needed. It also includes 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 day by providing comfort and relief.
To be eligible for Hospice services, the patient must meet certain criteria:
- The patient is eligible for Medicare Hospital Insurance (Part A).
- The patient's doctor and the hospice medical director certify that the patient is terminally ill with six months or less to live, if the disease runs its expected course.
- The patient signs a statement choosing hospice care instead of standard Medicare benefits for the terminal illness only.
- The patient receives care from a Medicare approved hospice program.
According to Medicare, Hospice care 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.
- physicians' services
- nursing care (intermittent with 24 hour on call service)
- medical appliances and supplies related to the terminal illness
- outpatient drugs for symptom management and pain relief
- short-term acute inpatient care, including respite care
- continuous care at home during periods of crisis
- health aide and homemaker services
- physical therapy, occupational therapy and speech/language pathology services
- medical social services
- hospice friend services provided by trained volunteers
- bereavement services
For details concerning these services, click here
How long can Hospice care continue?
Special benefit periods apply to Hospice care covered under Medicare:
- A Medicare beneficiary may elect to receive hospice care for two 90 day periods, followed by an unlimited number of 60 day periods.
- 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 has the right to cancel hospice care at any time and return to standard Medicare coverage. He/She may later re-elect the hospice benefit.
- A beneficiary who was in their fourth benefit period when discharged from hospice may re-elect, providing the physician's certification includes specific clinical finding and supporting documentation. This re-election will begin a 60 day period, followed by unlimited 60 day periods providing the patient remains hospice appropriate.
How is payment made under Medicare coverage?
Medicare pays the hospice directly at specified rates depending on the type of care given.
The patient is responsible only for:
- Drugs or biologicals: Hospice may charge 5% of the reasonable cost, up to a maximum of $5 for each prescription for pain relief and symptom management related to the terminal illness. However, Hospice of the Plains does not charge medication co-payments to patients who are on Medicare.
- Inpatient Respite Care: Hospice may periodically arrange for inpatient care for the patient to give temporary relief to the person who regularly provides care in the home. This care is limited each time to a stay of no more than 5 days and the charge (currently 5%) is subject to change each year and may vary slightly depending on the geographic location.
Are other Medicare benefits available?
When a Medicare beneficiary chooses hospice care, he or she gives 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 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 under Medicare?
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:
- Treatment for the terminal illness which is not for symptom management and pain control as delineated by the Plan of Care.
- Care given by another healthcare provider (such as another hospice or a home health care agency) that was not arranged for by the patient's hospice.
- Care from another provider which duplicates care the hospice is required to provide.