Hospice care isn’t something people like thinking about, but the focus of hospice is a patient’s quality of living at the end of life. Medicare hospice includes a core team that provides medical, psychological, and spiritual support for terminally ill patients.

The Medicare hospice team can include nurses, doctors, volunteers, home healthcare aides, and counselors. It must be a Medicare-approved hospice organization for Medicare to pay for the services.

Typically there will be a doctor or nurse on call 24 hours per day, 7 days per week.

Where is Hospice Administered?

Hospice care usually takes place in the home, so the patient can live out the rest of his or her life around family and loved ones. When care in the house is not possible, hospice administers inpatient care at a Medicare-approved hospice facility, hospital, or skilled nursing center.

When is Hospice Care Needed?

Suppose the healthcare provider gives a terminal projection. In that case, you can decide when you feel hospice care is appropriate instead of continuing to treat the condition. You would then choose which Medicare hospice program you would like to join.

A doctor that’s approved by Medicare must say that you have an illness or disease with a life expectancy of six months or less.

If your condition goes into remission, you have the right to return to your former Medicare treatment. Always consult your doctors as you make this tough decision.

Do I Pay Anything for Hospice?

Once you start hospice, you do not pay anything for hospice care. Prescription drugs to help with pain and symptom management will have a $5 copay. Suppose you need to go into the hospital for respite care. In that case, you may be responsible for 5% of the Medicare-approved amount.

To find out precisely what you’ll pay, speak with your health care provider. Things that factor in are other insurance, how much your doctor charges if your doctor accepts Medicare assignment, and where you get the service completed.

Does Hospice Cover Everything?

Hospice care will not cover a few things at the start. Prescription drugs to treat your health condition or illness, except for symptom control or pain relief.

When you choose a hospice provider, you must receive care from someone assigned by them. Hospice doesn’t cover you if you have care from someone outside of the hospice program you selected.

Since you’ve chosen to start hospice care, treatment to cure your terminal illness will no longer be covered. You do have the right to stop hospice at any time.

Ambulance rides during inpatient and outpatient hospital care are omitted unless it is arranged by your hospice team or it’s unrelated to your terminal illness.

Medicare doesn’t cover room and board in a home, a hospital, skilled nursing, or hospital facility. If your hospice team arranges it for a short-term basis, it will be covered, and you will have a small co-insurance to pay.

Contact your hospice team before the rendering of these services.

What are Medicare-approved Hospice Services?

Part A of Medicare covers hospice care. Medicare-covered care services include:

  • Nutritional counseling
  • Social worker services
  • Grief counseling for you and your family
  • Medical supplies and equipment
  • Medicare hospice aide and homemaker services
  • Physician services
  • Nursing care
  • Short-term respite care
  • Short-term inpatient care
  • Prescription drugs for symptom control and pain relief
  • Your Medicare hospice team recommends Medicare-covered services to manage your pain and other symptoms related to your terminal illness.
  • Hospice and Medicare Advantage plans

With a Medicare Advantage plan, the insurance company takes over and administers your Medicare benefits through the Medicare Advantage plan. Usually, you cannot use any provider or service not approved by the program.

Hospice is the exception to this since it is covered by Medicare Part A. Hospice covers all related Medicare-approved services, not just the treatments and services related to your terminal condition.

FAQs

What are the four levels of hospice care?

Medicare requires approved hospice providers to offer four levels of care.

  1. Hospice care at home – Routine visits from the hospice care team
  2. Continuous hospice care – 24/7 Hospice care to handle symptoms and keep you from needing hospitalizations
  3. Inpatient hospice care – Hospice provides care in a Hospice care facility until the patient can return home.
  4. Respite care – Care in an inpatient facility to give the primary caregivers a break. This helps keep caretakers from burning out and allows them to provide more efficient care.

Do hospice nurses stay overnight?

Unless it is an emergency, hospice nurses do not stay overnight.

Can you go on and off hospice care?

Yes. A patient can end hospice care at any time, and once they do, they can pursue or give traditional treatments another try.

What diagnosis qualifies for Hospice care?

Medicare considers any diagnosis life-limiting with a life expectancy of six months or less.

Does long does Medicare pay for hospice?

Medicare grants patients two 90-day benefit periods initially. But after that, it gives continuous 60-day benefit periods.

Can I change my hospice provider?

Yes, you can change your hospice provider once during each benefit period.

How often do hospice team members visit?

Hospice team members see their patients two to three times per week. The visits can increase or decrease in frequency based on the patient and family’s needs.

Does hospice stay around the clock?

Hospice nurses don’t stay overnight, so their hospice teams have an on-call nurse that answers the phone day and night. This nurse can make additional home visits or send a team member between scheduled visits.

Can family members stay overnight in hospice?

Hospice can make exceptions that allow family members to stay overnight. These compassionate care visits happen more frequently if the patient declines in health. If the patient has his or her own room, hospice approves overnight visits more regularly.

Who decides if hospice is needed?

The patient, healthcare providers, and families make that determination together.

Getting Help With Setting Up Hospice Care

If one of your loved ones is ready to enter hospice care, we can assist in making that transition easier. Call us today, and we can have a licensed agent answer your questions.

Licensed agents can assist in choosing the best Medicare plan for your needs. If you’d rather not call, fill out our simple online request form to get connected with the best rates in your area.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.