Medicare Guidelines for Hospice Care

Medicare is offered in four parts. Part A is sometimes called hospital Medicare because most of its benefits apply to hospital services. Hospice care is included in Medicare Part A. Hospice is palliative care intended to make people with terminal illnesses comfortable and pain-free in the final stages of the illness. Hospice care providers and patients must meet certain criteria to be approved for Medicare benefits.

Medicare Approval

• To receive Medicare benefits for hospice, you must be enrolled in Medicare Part A, and you must qualify for hospice care. That means your primary physician must certify that you have a terminal illness and have no more than six months to live. You also must personally sign a statement choosing hospice care, and receive your services from a hospice program approved by the Centers for Medicare and Medicaid Services.

Hospice Benefits

• Your hospice care will be provided by an entire hospice team. Hospice patients usually receive their care at home, a less stressful and isolating environment than a hospital. Your care team may consists of many professionals, such as hospice doctors, nurses, nursing assistants and social workers. Trained volunteers also will be available. Your own doctor can become a member of the hospice team if he wishes. Medicare also will continue to pay for health problems that are not part of your terminal condition. Hospice benefits are specifically only for doctor and nurse visits, medical equipment, medical supplies, prescription medications, short-term in-patient hospital care, social workers, respite care and grief counseling.

Services Not Covered

• If you change your mind about hospice and want to begin aggressive medical treatment against your condition, that treatment will not be considered hospice, and will not be covered as a hospice benefit.

  You cannot get your hospice services from any and all hospice providers. Your care must be arranged by your hospice team, unless you decide to change providers.

  Room and board in a nursing home or hospice-care facility will not be covered by Medicare Part A, nor will trips to the emergency room, ambulance transportation or in-patient services, unless they are the result of conditions or accidents unrelated to your terminal condition, or have been planned and arranged by your hospice team.

Role of Volunteers

• In order to keep hospice costs down, Medicare mandates that at least 5 percent of your total patient care be done by a volunteer. The volunteer must be trained and can be chaplains, homemakers or respite caregivers. The hospice must keep accurate records to show the cost savings of the use of volunteers.