Hospice is covered by Medicare, Medicaid / Medi-Cal, and most private insurance plans. Established in 1982, The Medicare Hospice Benefit provides patients experiencing life-limiting illnesses compassionate, coordinated care to help manage the symptoms and consequences of their disease.
The Hospice Benefit is designed to assist terminally ill patients with the often-significant expenses incurred at the end of life. The Benefit includes prescription coverage for illness-related medications, comfort medications, medical equipment and supplies, and counseling and spiritual support for patients and their families. For Medicare Hospice coverage, patients must:
– Be eligible for Medicare Part A.
– Consent to hospice care and agree to receive “palliative” rather than curative care.
– Be certified by his or her physician and the hospice medical director as having a “medical prognosis that his or her life expectancy is six months or less, if the illness runs its normal course.”
– Continue to have a six-months-or-less prognosis, although some individual patients may receive hospice services for longer than six months as long as they continue to have a limited life expectancy throughout that time.
Medicare Hospice Benefit
Medicare will reimburse the cost of hospice care under your Medicare Hospital Insurance (Part A). Medicare patients have no charges after they meet their deductibles. When all requirements are met, Medicare will cover the following:
Services Covered Provided as Appropriate Developed in the Plan of Care:
– Physician services
– Nursing care
– Medical equipment and supplies as relative to terminal illness
– Medications for symptom management and pain relief of the terminal illness (must be pre-approved by hospice)
– Short-term inpatient care for pain and symptom control
– Respite care for up to five days
– Home health aide
– Spiritual counseling
– Bereavement counseling
– Physical therapy, occupational therapy, speech therapy
– Medical social services
– Dietary and other counseling
– Volunteer services
Non-Covered Services:
– Treatment for the terminal illness which is not for palliative symptom management and is not within the hospice plan of care
– Care provided by another hospice that was not arranged by the patient’s hospice
– Ambulance transportation not included in the plan of care
– Medications that are not related to the terminal illness
– Visit to the emergency department without the prior approval or arrangements by Hospice
– Inpatient care at non-contracted facilities
– Sitter Services/Hired Caregivers
– Admission to the hospital without the prior approval or arrangements by Hospice
– Lab studies, X-rays, medical testing and/or any treatment not indicated
– Room and board if you are a resident of a nursing home
– Blood or platelet transfusion unless approved by the Hospice
Charges
In most cases your insurance company will pay Hospice directly. However, not all insurance plans provide full coverage for hospice care and some hospice services may not be covered under your plan. We receive our reimbursement from Medicare, Medi-Cal and private health insurance for services. All third-party payors are billed for hospice services as appropriate. Medicare and Medi-Cal patients have no charges after they meet their deductibles.
Our social workers will meet with patients and their families to determine concerns and needs.
Should any change be made in this policy regarding services or charges, the patient and/or responsible party will be advised. If there are any questions about charges or insurance billing, please call our office at 909-882-8466.