Hospice Medicare Regulations

Medicare Part A contains a provision for hospice care as well as home health and hospital in-patient services. Hospice care is medical and palliative care given to people in the last stages of a terminal illness. The focus of hospice is not to cure the disease but to make the person as comfortable and pain-free as possible in their last days, allowing them to die with dignity. Hospice caregivers and institutions must be licensed by the state, and both the agency and the patient must meet certain conditions before being approved for Medicare benefits.

Eligibility

• In order to receive Medicare benefits for hospice, you must first, of course, be eligible for Medicare. Medicare is a federal health insurance program primarily for citizens aged 65 or older. Medicare comes in four parts, but you must at least qualify for Medicare Part A, also called original or traditional Medicare. Once you have been approved for Medicare, you must then also qualify for hospice. Hospice is meant for the dying, and in order for Medicare to pay benefits, your doctor must certify that you have a terminal illness and more than likely have fewer than six months to live. You must also get your care from a hospice program approved by Medicare and personally sign a statement choosing hospice over other kinds of medical care.

Hospice Benefits

• Once you qualify, you will start receiving services from a hospice team. People usually receive hospice care at home, where they can be more comfortable, rather than in a hospital. People on your care team may include hospice doctors, nurses, nursing assistants, social workers and volunteers. Your own regular doctor can also be part of the hospice team. In fact, only your regular doctor can certify that you are in the last stages of a terminal illness. Medicare will still pay for health problems which are not part of your terminal conditions, but hospice benefits are for doctor and nurse visits, medical equipment, supplies such as bandages, prescription drugs, therapy, short-term in-patient care, social worker services, short-term respite care and grief counseling for your family.

Services Not Covered

• Not all services during your illness will be covered by Medicare however. If you change your mind and want to begin aggressive, curative care against your condition, this is not hospice and will not be covered as a hospice benefit. This means both prescription drugs meant to cure your illness and curative treatments. You are also not allowed to get care from a hospice group other than the one you have chosen. All your care must be arranged by your hospice team, unless you decide to completely change hospice providers. Medicare hospice benefits also do not cover room and board in a nursing home or hospice-care facility. Emergency room, ambulance transportation or in-patient facility services are not covered unless they are arranged by your hospice team or are used for reasons unrelated to your terminal condition.

Volunteers

• In order to keep hospice costs down, Medicare mandates that some of your hospice care must be done by a volunteer. The volunteer must be trained and may function in various capacities, such as chaplains, clergy, homemakers and respite caregivers. The hospice must then maintain records regarding the cost savings they have managed through using volunteers.