Hospice Expert
April Smith is the marketing director for South Wind Hospice, which serves 17 counties...read more
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Hospice
Hospice: Discover a Free Medicare Benefit
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Comments (6)
Hospice services are available twenty-four hours a day, seven days a week. There is always a nurse on call at night and on weekends. The nurse will visit a patient as long and as often as necessary to ensure quality care. Because of this wonderful service, many people are under the impression that hospice care is expensive, and believe they cannot afford such treatment. However Medicare, Medicaid and private insurance companies cover hospice care and services.
This would include, but is not limited to, medications, medical supplies, nursing care, home health aides and social services. In 1983, Congress established the Medicare Hospice Benefit, covered under Medicare Part A, to ensure that all beneficiaries could receive high-quality end-of-life care. In order to receive the Medicare Hospice Benefit, the patient must meet three key criteria.
First, the patient’s doctor must certify—in his or her best clinical judgment—that the patient is terminally ill with a life expectancy of six months or less. If the patient lives longer than six months, he or she can continue to receive hospice care as long as the doctor re-certifies that the patient is terminal and with declining health.
The second key criterion is that the patient is willing to receive comfort care instead of curative treatments for their illness. For example, a patient could not be getting chemotherapy to cure their illness and be getting hospice care simultaneously. Hospice is intended be used once curative treatment is no longer an option. Finally, the patient needs to enroll in a Medicare-approved hospice program. This should be one of the first questions you ask in determining which hospice agency to use. More than 90% of hospices in the United States are certified by Medicare.
Spreading the word—
April Smith
Posted in Hospice & Palliative Care, Hospice Care, Hospice: April Smith, Medicare & Hospice, Medicare & Medicaid, Paying for Long Term Care
so you said that medicare covers hospice…do they pay a certain percentage of it? or all of it?
Medicare covers 100% of hospice care. Medications will also be covered as long as it pertains to the hospice diagnosis. For example, if someone is on hospice because of heart disease, then Medicare may not cover medication for depression, and so on.
i always thought that someone from hospice stays at your home during the process. but i just heard from a friend of mine that they just stop by a couple times during the week to drop off medication and provide a little support. Is this governed by medicare? does it differ around the country?
Stevie,
Hospice staff is on-call 24 hours a day 7 days a week and makes regular visits depending on the need of the patient. However, they do not stay at your home. Hospice nurses can have many patients at one time and takes turns visiting with them. The amount of support, time, and care depends on the individual patient and their need for extra care. This is all part of your hospice benefit through Medicare. It’s also important to know that every hospice is different. Although the main concept is the same, each hospice can vary. Some are for-profit and others are non-profit. Some provide better care, or have a hospice home, or offer extra services. I recommend researching a hospice before making a decision. Find out what they have to offer you and your family. You choose whether or not to have hospice care and you choose who will provide that care.
I hope this helps,
April
I read your response and noted it stated that 100% of all hospice expenses are covered by Medicare. Did I misread or misunderstand? It is on a per diem basis which on some days and for some people all days can exceed the per diem allowed. Do not hospices have to absorb that overage or am I misunderstanding your answer. Thank you I am always trying to learn something new
Sherry,
Thanks for your question. What I was trying to say is that everything pertaining to the terminal diagnosis is covered by hospice so patients and families will not be charged for hospice services. Medicare reimburses hospice at a set daily rate. For more than 96% of Medicare hospice patients, the rate is approximately $126 per day. This is the reimbursement the hospice receives regardless of how much is spent on equipment, meds and supplies. Hospices caring for patients without Medicare or any other form of insurance do not qualify for reimbursement. In order to absorb any loses most non-profit hospice organizations participate in fundraising while also accepting donations, but do not charge the patient. (Note: Not all hospices are the same so it never hurts to confirm what services they offer.)
Medicare recipients do not pay for hospice care, but may have to pay some auxiliary costs in certain circumstances. Patients will need to pay for meds outside the primary diagnosis of hospice (so any drug which is not a part of the hospice care). Also anyone with Medicare Part D will continue to pay. (Monthly payments do not increase with a hospice diagnosis.) In a hospice facility the patient may be expected to pay room and board if they are using the home as a permanent residence; however, respite care is covered by Medicare for five days of stay in a hospice facility.