Medicare Requirements for Hospice Care

Hospice is palliative care given to someone diagnosed with a terminal illness. The emphasis in hospice is on making the patient comfortable and relieving her pain rather than trying to fight the illness. Hospice care is usually provided by private hospice companies and is covered by some kinds of health insurance. Medicare also provides benefits for hospice services, but there are certain conditions which must be met before Medicare will cover it.

Eligibility

• You must be eligible for and enrolled in Medicare Part A before you can receive hospice benefits. Medicare is used primarily by United States citizens 65 years or older, although some people younger than 65 may also use it if they have certain disabilities or diseases. Enrollment in Medicare does not make patients automatically eligible for hospice care though. Both a doctor and the director of the hospice must certify that the patient has less than six months to live, and the patient must sign a statement agreeing to hospice care.

Providers

• Hospice services must be obtained through a provider specially approved by the Centers for Medicare and Medicaid Services. Providers need to be specifically approved for hospice, even if they already have approval for other kinds of health care. Physicians, hospice associations, Social Security offices and state health departments should be able to tell you if a hospice provider is approved by Medicare or not.

Length of Time

• Medicare hospice benefits are offered in benefit periods. Two 90-day periods are allowed first, followed by 60-day periods. There is no limit on the number of 60-day periods you can use. These can be used one after the other or in intervals. It is possible to cancel hospice care and then resume it at a later time. However, once you cancel hospice care, any days left in your care period are lost. Patients are allowed to change hospice providers once every benefit period.

Volunteers

• Volunteers have an important role in hospice care. They can relieve family members and caregivers of their duties for a short period of time and help with shopping, transportation, housekeeping and generally supporting the patient and his family. They also spend quality time with the patient. Medicare mandates that a minimum of 5 percent of hospice care comes from volunteers. Hospice providers must also submit reports detailing cost savings derived from using volunteers.

Benefits

• Medicare hospice benefits will cover drugs for pain relief, nursing services, respite care, social services and medical equipment. However, Medicare will not cover room and board in a hospice facility unless this is necessary to provide symptom and pain relief which cannot be done at home. It will also not cover services you get from a hospice provider which is not the one you have already chosen. Health problems not related to the terminal illness will still be covered.