Medicare Eligibility requirements and guidelines for Hospice Care

By: Barbara M., Published: Apr 20, 2020 | Related: Medical Bills Assistance

Many people have a difficult time dealing with the fact that they have to put their loved one in hospice. The good news is that Medicare beneficiaries will be able to get all or part of their hospice expenses covered. People choose hospice care when they decide that they do not want to cure their illness. They may also decide that their treatments are no longer working.



The Changing Environment

Hospice has been available in the United States since the 1970s. Most of the people who were in hospice were cancer patients. That is not true today. Most of the patients who are in hospice today suffer from other diseases such as heart disease, kidney failure, Alzheimer's disease. Medicare benefits will cover all of those conditions.

Eligibility

If you need to get Medicare benefits, then you will need to be enrolled in some type of Medicare health benefits. It does not matter whether it is the Original Medicare or one of the Advantage Plans. In order to get coverage, you will need to get a statement from a physician saying that the patient is terminally ill. The statement also says that the patient has chosen hospice over a medical treatment. Medicare must approve the hospice program.

Certification

In order to be certified, two medical doctors have to agree on the patient's prognosis. One has to be a hospice physician. The other one has to be your family doctor. Both of the physicians have to agree that the patient will not live longer than six months. If the patient lives longer than six months, then you can submit another form to see if you can continue to get coverage.



What Type of Services are Covered?

There are a variety of hospice services that are covered by Medicare. This includes services that are provided by doctors, therapists, aides and nurses. Services that are provided by homemakers, social workers and grief counselors may also be covered by Medicare. If the patient needs additional equipment, supplies and medication, then this can be covered.

Respite care is something else that can be covered by hospice. This means that a patient can stay in a facility for a few days in order to give the caregiver a break.

Out-of-Pocket Expenses

Medicare will not pay for prescription drugs unless the patient is taking them to control the symptoms of the terminal illness. If a patient in hospice care receives treatment that is not related to chronic illness, then you will have to pay for the treatment yourself.

For example, if the patient had to pay deductibles and copayments for care that is not related to hospice, then this will continue after you get hospice. The patient may also be required to pay 5 percent of the cost of respite care out-of-pocket.

Things That Will Not be Covered

If you are receiving a treatment that is designed to cure your illness, then it will not be covered by Hospice. Consult with your physician if you are thinking about using a treatment to cure your illness. Keep in mind that if you are a hospice patient, then you will have the option of stopping it at any time.

You can use prescription drugs to control the pain and symptoms of your illness. If you use treatments from another hospice provider that was not approved by Medicare, then it will not be covered. However, you can still continue seeing your regular doctor.



Room and board is something else that may not be covered by Medicare if you receive the care in your home. You may also not get coverage if you receive the care in a nursing home. The only time that nursing home care will be covered if it is short-term. You will only have to make a small copayment. Contact your hospice team before you get any service done in order to ensure that it is covered.

What Determines the Coverage That You Will Get

The other type of insurance that you have will determine the amount of coverage that you get from Medicare. The amount that your doctor charges will also determine how much coverage that you get. The type of facility that you get will influence the cost of your Medicare.