Medicare/Medicaid

Medicare Hospice Benefits

You can get Medicare hospice benefits when you meet all of the following conditions:

• You are eligible for Medicare Part A (Hospital Insurance)
• Your doctor and the hospice medical director certify that you are terminally ill and have six months or less to live if your illness runs its normal course
• You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness*
• You get care from a Medicare-approved hospice program

   Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.

   What Medicare Covers

  The care you get for your terminal illness must be from a Medicare-approved hospice program.

  You can get a one-time-only hospice consultation with a hospice medical director or hospice physician to discuss your care options and management of pain and symptoms. You don’t need to choose hospice care to take advantage of this consultation service.

  Medicare covers the following hospice services for your terminal illness and related conditions:

  • Doctor services
  • Nursing care
  • Medical equipment (such as wheelchairs or walkers)
  • Medical supplies (such as bandages and catheters)
  • Drugs for symptom control or pain relief (you may need to pay a small co-payment)
  • Home health aide and homemaker services
  • Physical and occupational therapy
  • Speech therapy
  • Social worker services
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term inpatient care (for pain and symptom management)
  • Short-term respite care (you may need to pay a small co-payment)
  • Any other Medicare-covered services needed to manage your pain and other symptoms, as recommended by your hospice team

  Important: Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.

  Respite Care

  You can get inpatient respite care from a hospice if your usual caregiver (such as a family member) needs a rest. During this time, you will be cared for in a Medicare-approved facility, such as a hospice inpatient facility, hospital, or nursing home.

  What Medicare Won’t Cover

  When you choose hospice care, Medicare won’t cover any of the following:

  • Treatment intended to cure your terminal illness

  You should talk with your doctor if you are thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time and get the Medicare coverage you had before you chose hospice care.

  • Prescription drugs to cure your illness rather than for symptom control or pain relief
  • Care from any hospice provider that wasn’t set up by the hospice medical team

  You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice medical team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. • •

  Room and board

  Room and board aren’t covered by Medicare if you get hospice care in your home or if you live in a nursing home or a hospice residential facility. However, if the hospice medical team determines that you need short-term inpatient or respite services that they arrange, your stay in the facility is covered. You may be required to pay a small co-payment for the respite stay.

  Also not covered: care in an emergency room, inpatient facility care, or ambulance transportation, unless it’s either arranged by your hospice medical team or is unrelated to your terminal illness.

  Note: Contact your medical hospice team before you get any of these services or you might have to pay the entire cost.

  Source: Center for Medicare/Medicaid Services Medicare Hospice Benefits

  For the most up-to-date version, visit www.medicare.gov on the web. Under “Search Tools,” select “Find a Medicare Publication.” Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. A customer service representative can tell you if the information has been updated.

  
  Medicaid Hospice Benefits

  Hospice is an optional benefit for state Medicaid programs. Individuals who live in states that choose to provide a Medicaid hospice benefit may be able to obtain payment for hospice services even if coverage is not available under Medicare. (For example, if the individual does not have Medicare Part A.)

  An individual electing the Medicaid hospice benefit must be eligible for Medicaid in the state in which she resides. Limitations on co-payments and deductibles would be reflected in the state’s Medicaid plan in accordance with Medicaid law.

  Source: Center for Medicare Advocacy, Inc.  www.medicareadvocacy.org