Medicare will pay for hospice care as long as the hospice doctor certifies that a patient is terminally ill. A patient who is terminally ill means that the patient has a life expectancy of six months or less, assuming that the illness runs its normal course. If the patient lives longer than six months, the patient can still receive hospice care under one condition. This condition is if the hospice medical doctor or other hospice doctor recertifies that the patient is still terminally ill.
Hospice care is provided in benefit periods. A benefit period starts on the day the patient gets hospice care. A patient can get hospice care for two benefit periods, with each benefit period having 90 days. After those 90-day benefit periods, they are followed by unlimited 60-day benefit periods. At the start of the 90-day benefit period, the patient’s hospice doctor or regular doctor must certify that the patient is terminally ill. After the 90-day benefit period, the next benefit period requires the patient’s hospice medical physician or other hospice physicians to recertify that the patient has a terminal illness.
Yes, Medicare pays for hospice care. Palliative hospice care is only given as end-of-life care. End-of-life
care aims to alleviate the symptoms of the patient’s terminal illness. Terminal illnesses include Alzheimer’s disease, pulmonary disease, cancer, amyotrophic lateral sclerosis (ALS), dementia, congestive heart failure, end-stage renal disease, end-stage renal disease, Parkinson’s disease, HIV/AIDS, and others. Palliative hospice care through the palliative care team improves the quality of life of the patient in the patient’s final months of life.The patient’s hospice health professional and the patient’s medical doctor must certify if the patient qualifies for palliative hospice care. Palliative hospice care is covered under Medicare Part A. Medicare Part A is hospital insurance, which is any service required in an inpatient setting.
Medicare Part A covers the following services such as inpatient hospital care, inpatient mental health services, inpatient
rehabilitation services, hospice care, limited home healthcare, and limited stays in a skilled nursing facility.
Medicare also works with the patient’s Medicare-accredited hospice team to create a hospice plan of care. The plan of care includes the following Medicare-covered services:
Yes, Medicare will pay for hospice care at home. Medicare-certified hospice care for patients is usually given in the patient’s home or another facility where the hospice patient lives, such as a nursing home or assisted living facility, according to Medicare. Medicare also states that the patient can also receive hospice care in an inpatient facility.
An inpatient hospice facility is where the patient stays when the symptoms need additional medical attention that is not present in a home environment. The goal of inpatient hospice care is to control the patient’s symptoms so that the patient can go back home to continue receiving hospice care. Inpatient care at a hospital must be arranged by the hospice provider because the patient’s hospice benefit is paid to the hospice provider, according to Medicare. Medicare also states that the hospice providers and the hospital have a contract to work out the payments between them. If the patient goes to a hospital that’s in not arranged by the patient’s hospice provider, the patient might end up paying the entire amount of inpatient hospice care at the hospital.
Yes, Medicare Part B also pays for hospice care. Medicare Part B, together with Medicare Part A, constitutes the Original Medicare. Original Medicare does pay for hospice care as long as the hospice provider is enrolled in the program and accepts Medicare coverage.
Medicare Part B covers outpatient medical and nursing services, medical equipment, and other treatment services. Hospice care may require these services that are covered by Medicare Part B as long as they’re to alleviate the symptoms of the patient and not to cure or treat the patient’s terminal disease.
Medicare Part B has durable medical equipment (DME) coverage. This coverage can be used at the patient’s homes as ordered by the patient’s Medicare-enrolled doctor or other health care provider. DME that Medicare covers include the following:
These DMEs may be needed in hospice care and can be bought or rented by the patient. The patient needs to pay for the Medicare Part B deductible, which is $226 for 2023, according to Medicare. After paying for the Medicare Part B deductible, the patient will pay 20% of the Medicare-approved amount. The Medicare-approved amount is the total payment that Medicare agrees to pay a health provider for a service or item.
Yes, Medicare Part A pays for hospice care. Hospice care is fully covered by Medicare as part of the Original Medicare. Hospice care involves a hospice team that includes doctors, nurse practitioners, social workers, nutritionists, counselors, and chaplains. These experts provide hospice services that address the medical, physical, social, emotional, and spiritual needs of the patient. The patient’s family caregivers and family members are also supported by the hospice program.
Hospice care, through the Original Medicare coverage, requires the patient to pay a copayment of up to $5 for each outpatient prescription drug for symptom control and pain management. A co-payment is a fixed amount that the patient is required to pay as a share of the cost of a medical service or supply. A medical service or supply includes a doctor’s visit, a hospital outpatient visit, or a prescription drug. If a drug is not covered by the hospice program, the hospice provider can check Medicare Part D (Prescription Drug Coverage).
Patients with hospice benefits under Medicare Part A are also required to pay 5% of the Medicare-approved amount for inpatient respite care. Inpatient respite care is used to provide temporary relief to patient’s primary caregivers and give them time to recuperate and attend to their personal needs.
Patients under Medicare Part A coverage may also have to pay for the room and board if the patient lives in a facility such as a nursing home and the patient chooses hospice care.
Yes, Medicare pays for hospice caregivers and hospice providers as long as they are enrolled in Medicare. Medicare may require hospice caregivers and providers to meet specific Federal requirements in order to be Medicare-certified. To be Medicare-certified, the hospice provider and supplier must complete the enrollment process through a CMS-approved Medicare accreditation program. The Centers for Medicare and Medicaid Services (CMS) use this protocol to ensure that the hospice providers and suppliers meet the requirements.
No, Medicare does not cover 24-hour in-home hospice or continuous home care. Aside from in-home hospice or continuous home care, Medicare does not also cover the meals delivered to the patient’s home, homemaker services, such as shopping, cleaning, and laundry, and custodial or personal care that assist the patient with activities of daily living (ADLs) like bathing, dressing, and using the bathroom.
On the other hand, Medicare provides coverage for doctors and hospice nurses to be available on-call around the clock for patients. Patients with too complex needs for in-home care can receive short-term inpatient care or respite care. Inpatient care must be in a Medicare-approved facility such as a hospice facility, a hospital, or a skilled nursing facility. For respite care, patients can stay at a Medicare-approved facility such as an inpatient facility, hospital, or nursing home for up to 5 days each time, with succeeding sessions on an occasional basis.
For more information on Medicare Pay For Hospice Care contact Specialized Home Care today.