Hospice Expenses

What Medicare Covers
Who is Eligible?
For How Long?
How is Payment Made?
Other Medicare Benefits
What is Not Covered?

Hospice Care and Medicare
Hospice care is a special way of caring for a patient whose disease cannot be cured. It is available as a benefit under Medicare Hospital Insurance (Part A). Special rules govern Medicare's coverage of, and payment for, hospice care. Medicare beneficiaries who choose hospice care receive non-curative medical and support services for their terminal illness. Other medical conditions unrelated to the terminal illness continue to be covered under your primary insurance.

Under the Hospice Medicare Benefit, Medicare covers:

	physicians' services,
	nursing care (intermittent with 24-hour on call),
	medical equipment and supplies related to the terminal illness,
	outpatient drugs for symptom management and pain relief,
	short-term acute inpatient care related to the terminal illness, including respite care,
	home health aide and homemaker services,
	physical therapy, occupational therapy and speech/language pathology services,
	medical social services, and
	counseling, including dietary and spiritual counseling.

Who is Eligible?

While hospice patients no longer receive treatment toward a cure, they require close medical and supportive care which a hospice can provide. Hospice care under Medicare includes both home care and inpatient care, when needed, and 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 hour and each day of remaining life by providing comfort and relief from pain.

Hospice care is available under Medicare only if:

The patient is eligible for Medicare Hospital Insurance (Part A);

he 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 an election statement choosing hospice care instead of standard Medicare benefits for the terminal illness;

The patient receives care from a Medicare-approved hospice program.

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How Long can Hospice Care Continue?

Special benefit periods apply to hospice care. A Medicare beneficiary may elect to receive hospice care for two 90-day periods, followed by an unlimited number of 60-day periods. The benefits periods may be used consecutively or at intervals. Regardless of whether they are used one right after the other or at different times, 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 also has the right to cancel hospice care at any time and return to standard Medicare coverage, then later reelect the hospice benefit in the next benefit period.

How is payment Made?

Medicare pays the hospice directly at specified rates depending on the type of care given each day.

The patient is responsible only for:

Drugs or biologicals: The hospice can charge 5 percent of the reasonable cost, up to a maximum of $5, for each prescription for outpatient drugs or biologicals for pain relief and symptom management related to the terminal illness.

Inpatient Respite care: The hospice may periodically arrange for inpatient care for the patient to give temporary relief to the person who regularly provides care in the home. Respite care is limited each time to a stay of no more then 5 days. The charge (currently 5%), which is subject to change each year, varies slightly depending on the geographic area of the country.

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Are Other Medicare Benefits Available?

When Medicare beneficiaries choose hospice care, they give 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 the 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?

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;
	Care given by another healthcare provider that was not arranged for by the patient's hospice; and
	Care from another provider which duplicates care the hospice is required to provide.
	Room and Board charges when a patient's primary residence is a skilled nursing facility

Portions excerpted from the Medicare Hospice Benefit, a publication of the U.S. Department of Health and Human Services, Health Care Financing Administration.