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Medicare Hospice Benefit

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Hospice care provided by Medicare certified hospice programs is covered under Medicare Part A.  Attending physician and attending nurse practitioner services can continue to be billed through Medicare Part B.

Medicare beneficiaries who choose hospice care receive non-curative, palliative medical and support services for their terminal illness. Home care may be provided along with necessary inpatient care and a variety of services not otherwise covered by Medicare.

Who is eligible for care?

Medicare coverage for hospice care is available only if

• The patient is eligible for Medicare Part A;
• The patient’s attending physician, if the patient has one, and the hospice Medical Director certify that the patient is terminally ill, if in their judgment the patient has a life expectancy of six months or less as the disease runs its normal course;
• The patient or the patient’s representative signs a statement choosing hospice care instead of standard Medicare benefits for the terminal illness; and
• The patient receives care from a Medicare-certified hospice program.

How long are benefit periods?

When a Medicare beneficiary elects to receive hospice care, he or she is entitled to receive care for two 90-day benefit periods, followed by an unlimited number of 60-day periods.  At the start of each period of care, the patient’s physician must certify the patient is terminally ill.  A period of care starts when the patient begins to receive hospice care, and it end when the 90 or 60 day period ends.  The benefit periods may be used consecutively or at intervals.  The Medicare Hospice Benefit is not limited to six months.

What services aren’t covered?

All services required for the management of the terminal illness must be provided by or through the hospice.  When a Medicare beneficiary chooses hospice care, Medicare will not pay for:

• Active treatment of the terminal illness that is not for symptom management and pain control;
• Care provided by another hospice that was not arranged by the patient’s hospice;
• Care from another provider that duplicates care the hospice is required to furnish;
• Services which are not part of the hospice Plan of Care.

How much are out-of-pocket costs?

• No more than $5 for each prescription drug or other similar product
• 5% of the Medicare payment amount for inpatient respite care

Availability of other Medicare benefits

When a Medicare beneficiary chooses hospice care, the person waives the right to standard Medicare benefits for the management of the terminal illness.  A patient can use all appropriate Medicare Part A and B benefits for the treatment of health problems unrelated to the terminal illness.  Also, upon revocation of the Medicare hospice Benefit the patient immediately reverts to prior coverage.

Why might hospice services stop?

Sometimes a patient’s condition improves while on hospice care.  If that happens, the physician may feel hospice services are no longer needed and may not re-certify the patient for hospice care.  A person always has the right to stop receiving hospice services, as well.  If a patient stops his or her hospice care, he or she will receive the type of Medicare coverage that was provided before electing the Hospice Medicare Benefit.  If the patient is still eligible, he or she can always go back to hospice care at any time.