Eligibility for hospice care
Our Promise: Care for Everyone Who Needs it
We know your focus should be on your family and not on financial resources. We are here to help you navigate the complexities of insurance and billing, ensuring that financial concerns never stand in the way of the care your loved one deserves.
Comprehensive Coverage for Peace of Mind
Hospice care is a covered medical benefit designed to provide the resources a family needs during a serious illness. For the vast majority of our patients, there are no out-of-pocket costs for medical care, equipment, or medications related to their diagnosis.
Medicare & Medicaid
Most patients utilize the Medicare Hospice Benefit, which has provided comprehensive coverage for essential care since 1983.
Private Insurance
We partner with most major insurance providers to ensure your benefits are maximized.
Paying for Hospice Care
Hospice care is a specialized medical service covered by Medicare, Medicaid, Veterans’ benefits, and most private insurance providers.
Who is eligible for Hospice Benefits under Medicare?
Hospice Benefits are available to Medicare beneficiaries who:
- Are certified by a physician as having a life-limiting diagnosis,
- sign a statement choosing Hospice Care using the Medicare Hospice Benefit, and
- enroll in a Medicare-certified Hospice program.
What services are covered under the Medicare Hospice Benefit?
The Medicare Hospice Benefit covers the following services as they relate to the hospice diagnosis:
- Physician services for medical oversight of the patient’s care
- Home care visits by registered nurses to monitor the patient’s condition and care
- Home health aide visits to assist with dressing, bathing, and personal needs
- Spiritual support for the patient, if desired
- Social work or counseling services
- Medical equipment
- Medical supplies
- Medications for symptom control and pain management
- Volunteer support
- Dietary counseling
- Bereavement counseling and support services
Will the Medicare Hospice Benefit pay if I have to live somewhere else?
The Benefit provides hospice services delivered in hospice facilities, hospitals, long-term care facilities, and inpatient hospice units. However, the Benefit does not pay for room and board. In some instances, Medicaid will cover these expenses.
How long can a patient receive hospice care?
Hospice Care can be provided as long as the patient is certified as having a six month or less life expectancy. A patient can be re-certified for additional 60 and 90 day periods following the initial six months or less diagnosis. The Medicare Hospice Benefit is an unlimited benefit.
Can a patient change from one Hospice provider to another?
A patient has the right to change to another Hospice at any point, as long as the new Hospice is Medicare-approved.
What is not covered by the Medicare Hospice Benefit?
Services for conditions unrelated to the Hospice diagnosis and services for the hospice diagnosis that are not addressed on the hospice plan of care arranged by the hospice provider.
What expenses are paid for by the patient and family?
Medicare pays Hospice directly for a patient’s care. Patients can be billed up to five percent for outpatient drugs for pain management and symptom control. The patient may also be responsible for five percent of the Medicare payment amount for respite care if the service is used. Patients are also responsible for room and board at facilities, if necessary.
Why would someone stop receiving Hospice Care?
A patient can stop receiving Hospice Care at any time, for any reason. If a person stops Hospice Care, the standard Medicare Benefits are restored. Sometimes a disease may go into remission while receiving Hospice Care. A person’s condition may also change such that the patient no longer has a six month or less life expectancy. And, a patient may decide they may want curative treatment once again. At any point, a patient may return to hospice care as long as the eligibility criteria are met and certification by a physician is received.