Hospice Care Benefits

Hospice Care Benefits

One of the most difficult periods of time for a family occurs when one of the members of the family has a terminal illness. The stresses and strains are heart rendering. Many people who have terminal illnesses would rather spend their last remaining period of time in a home environment rather than in a hospital surrounding.

It is possible for a Medicare beneficiary under Medicare Hospital Insurance (Part A) to be covered for hospice care. Home care is provided along with any other necessary inpatient care and also some further services that would not ordinarily be covered under Medicare.

All of the following requirements must be met to be eligible for Medicare Hospice Benefits:

The patient must be eligible for Medicare Part A;
The patient's doctor and the hospice medical director certify that the patient is terminally ill with a life expectancy of 6 months or less;
The patient must sign a statement choosing hospice care instead of standard Medicare benefits for the terminal illness;
The patient receives care from a Medicare approved hospice program.

Under Hospice care the focus is on comfort and care, not cure. The hope is to provide relief from anxiety and pain for the terminally ill beneficiary. Believe it or not our old friend the Balanced Budget Act of 1997 requires Medicare Managed Care Plans to cover members who are terminally ill if they apply for the hospice benefit. The effective date for this rule is January 1, 1999.

The hospice uses the team concept in delivering the care to the terminally ill individual. The team consists of family, nurse, physician, social worker, dietician and clergy. Specialists are available when needed. A nurse and a physician are on call 24 hours a day, 7 days a week to provide advice over the phone or to visit when necessary. If the beneficiary is covered by Part B of Medicare the cost of a physician not affiliated with the hospice would be covered also. The public agency or private organization providing the hospice service must be approved by Medicare to provide hospice service.

Up until August 5, 1997, a Medicare beneficiary could elect to receive hospice care for two 90-day benefit periods, followed by a 30-day period, and when necessary, an extension period of indefinite duration. Beginning August 5, 1997, the hospice benefit period has two 90-day benefit periods, followed by an unlimited number of 60-day periods. The patient must be certified as terminally ill at the beginning of each period. The benefit periods may be used consecutively or at intervals. The patient has the right to cancel hospice care at any time by signing a written statement called a revocation statement. Upon revocation the beneficiary is returned to standard Medicare coverage. If a patient cancels during one of the benefit periods, any days left in that period are lost. There is no limit to the number of 60-day periods as long as the patient meets the requirements for the hospice benefit. The patient also has the right to change hospice programs (providers) once each benefit period.

Under the benefit if all requirements are met, Medicare covers:

Physician services
Nursing care
Medical appliances
Medical supplies
Outpatient drugs for symptom management and pain relief
Short term inpatient care, including respite care
Home health aide and homemaker services
Physical and occupational therapy
Speech/language pathology services
Medical social services
Dietary and other counseling

Medicare pays the hospice directly at specified rates depending on the type of care given daily. The patient is responsible only for:

Drugs or biologicals: the hospice can charge 5 % of the reasonable cost up to a maximum of $5, for each prescription for outpatient drugs or biologicals for pain relief and symptom management.

Inpatient respite care: the hospice may arrange periodically for inpatient care or skilled nursing facility care for the patient, to give temporary relief to the person who regularly provides the care at home. Respite care is limited each time to a stay of no more than 5 days, and the patient can be charged about $5 per day for inpatient respite care.

For further information on this topic call The National Hospice Organization at 1-800-658-8898 or write to them at 1901 North Moore Street, Suite 901, Arlington, VA 22209.