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A Quick Overview of Hospice

When you or a loved one becomes a Hospice patient, the last thing you'll want to worry about is insurance coverage. The final stages of a fatal disease can devastate a family mentally, emotionally, physically, and financially. Hospice care is available under Medicare Part A to help ease the burden for a family in all four of the above areas.

It is critical that a family has this coverage when a loved one reaches the final stages of cancer, kidney disease, or other similar life-threatening diseases. The patient will usually need around-the-clock care at home during this time, and Hospice workers can help relieve the family of some of the care-giving burdens as well as provide proper health care assistance that only a medical professional could provide.

What is Hospice Care?

Hospice is a Medicare program designed to provide care in a person's home for a person who has a terminal disease. A Medicare-approved Hospice will administer reasonable non-curative medical services and support for patients with a terminal illness. All services are designed to have a plan of care coordinated by the attending physician and the Hospice team.

Home and inpatient care are provided through Part A in addition to other services that are not otherwise covered by Medicare. A Hospice patient will no longer receive treatment to cure the illness. The Hospice program is designed to provide care and make the patient as comfortable and pain free as possible. The focus is to maximize the quality of life for each day the patient has remaining.

Hospice Eligibility

Not everyone is eligible for Hospice care. Certain requirements are laid out to ensure that only the patients and families who truly need Hospice services will receive them. The Hospice eligibility requirements are listed below.

  • The patient must be eligible for Medicare Part A.

  • A physician must certify that a person is terminally ill with a six-months or less life expectancy.

  • The patient is required to sign a statement acknowledging that they want Hospice care instead of standard Medicare benefits.

How Long Can a Person Receive Hospice Care?

Hospice care receives a special benefit period. The benefit period does not have to be consecutive. You can choose care for two three-month periods followed by unlimited two-month periods. The only requirement is that the patient is certified as a Hospice patient at the beginning of each period.

Hospice care can be altered once each benefit period. Hospice care may be cancelled at any time, and the patient may return to the standard Medicare benefits; however, any days remaining in that period will be lost. If later the patient wants to return to the Hospice care program, he/she may do so during the next benefit period. The exception to this is if the patient keeps the Medicare Part B plan. Part B may in this case be used for other services as long as they do not relate to the terminal illness.

What Does the Medicare Hospice Program Cover?

The Hospice program covered by Medicare includes physician services, intermittent 24-hour, on-call nursing care, any illness related medical appliances or supplies, and pain and symptom management outpatient drugs. The program also includes acute short-term and respite care, homemaker and home health aide services. Other services provided are physical and occupational therapy, speech-language pathology, medical social services, and counseling. Any and all services related to the treatment of the terminal illness have to be covered as well.

What the Medicare Hospice Program Does NOT Cover

There are some limitations to Hospice coverage. The treatments Medicare will not pay for include any treatment that is not for pain or symptom management. It also will not pay if the patient has an additional health care provider that covers the same services that Hospice provides.

What Are the Patient's Out-of-Pocket Expenses?

Your Medicare plan will pay the Hospice expenses. Costs will vary depending upon the care required. The patient will be responsible for the following:

  • Biologicals or Drugs - 5% of prescription cost with a $5 maximum.

  • Respite Care (inpatient)- 5% and may vary slightly with a five-day maximum stay.

Since the start of Hospice services many years ago, families all over the United States have benefited tremendously from the program. It's well worth looking into if you or a family member has been diagnosed with a terminal illness. It's good to understand your eligibility status and how Hospice works beforehand so you will be prepared if tragedy strikes your family.

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