Paying for Care
For most Hospice patients, the cost of hospice care is fully covered by the Medicare Hospice Benefit (under Medicare Part A, or hospital insurance). This benefit provides a daily allowance to the hospice organization, and in turn the hospice pays for all medical services, medications, durable medical equipment, supplies and treatments related to managing your serious illness as part of your individual plan of care. Like Medicare, Medicaid and most private insurance companies also provide coverage for hospice care. Private insurance benefits, deductibles and co-insurance requirements may vary by plan and are reviewed individually.
Common Questions about the Medicare Hospice Benefit:
Medicare beneficiaries must meet the following criteria to qualify:
- You must have Medicare Part A.
- You must enroll in a Medicare-approved hospice program such as Hospice & Community Care.
- Your doctor and the Hospice medical director must certify that you have a life-limiting illness with a probable prognosis of six months or less if the disease runs its normal course.
- You must sign a form indicating that you are electing your Medicare Hospice Benefit to cover the costs of services related to managing your illness.
Will I lose my Medicare coverage if I elect the Medicare Hospice Benefit?
Standard Medicare coverage for services unrelated to your life-limiting illness does not change and is not affected by electing the Medicare Hospice Benefit. Services related to your life-limiting illness and included in the hospice plan of care are covered by the Medicare Hospice Benefit.
Do I have to change doctors to receive care from Hospice & Community Care?
No. Hospice & Community Care works with your physician to provide the most comprehensive plan of care for you and your family.
Am I locked into using hospice care once I elect the Benefit?
No, you are not. You may revoke the Medicare Hospice Benefit at any time without penalty. You may also re-elect the Medicare Hospice Benefit at any time, provided you meet the qualifying criteria.
Is there a limit to how long I can receive hospice care if utilizing the Medicare Hospice Benefit?
Since no one can predict the course of a serious illness, there is no limit on the number of days a patient can receive hospice care. The Medicare Hospice Benefit consists of two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. Each benefit period requires medical certification of the life-limiting illness at the beginning of the period to continue receiving hospice services under the Benefit.
What costs are covered?
When deemed directly related to your serious illness, the following services are generally covered by the Medicare Hospice Benefit:
- Registered Nurses specially trained in pain and symptom management who make routine visits as needed
- Regular visits by Licensed Practical Nurses and Hospice Aides to provide personal care
- Social work and counseling services to provide emotional support for you and your family
- Spiritual care support for you and your family
- Visits by trained volunteers as needed
- Short-term inpatient care at the Bob Fryer & Family Inpatient Center or other approved facilities
- Temporary respite care at approved facilities
- 24-hour on-call medical services
- Dietary counseling
- Durable medical equipment (example: oxygen, hospital bed, walker, wheelchair, shower chair)
- Medical supplies (example: wound care supplies)
- Prescription medications (specified in your Plan of Care)
- Physical, occupational and/or speech therapy
- Other treatments and services related to managing your illness
What if I become ill and need to be moved to a different setting for care?
The Medicare Hospice Benefit pays for inpatient hospice care in a hospice center, hospital, or skilled nursing facility including Hospice & Community Care’s Bob Fryer & Family Inpatient Center. The Hospice & Community Care team will work with you and your family to determine the best setting for you to receive inpatient care.
What if I am in a senior care facility?
Your senior care facility and the Hospice & Community Care team will collaborate on your care. You will have the benefit of experts in long-term care working with experts in pain and symptom management as well as your personal physician. It adds up to the highest level of quality care for you and your family and, in some cases, Medicare may still provide coverage for hospice care even while helping to cover the costs of a senior living facility.
How can I learn more about this benefit?
You can find more information by calling Hospice & Community Care at (717) 391-2421. Additional information is also available by visiting the Centers for Medicare and Medicaid Services.