Does Medicare cover Hospice, Palliative & respite care
What about Medi Gap, Medicare Advantage & ACA/Obamacare?
Hospice is a program of care and support for people who are terminally ill (with a life expectancy of 6 months or less, if the illness runs its normal course) and their families. Here are some important facts about hospice:
■ Hospice helps people who are terminally ill live comfortably.
■ Hospice isn’t only for people with cancer.
■ The focus is on comfort (palliative care), not curing an illness.
■ A specially trained team of professionals and caregivers provide care for the “whole person,” including physical, emotional, social, and spiritual needs.
■ Services typically include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions.
■ Care is generally given in the home.
■ Family caregivers can get support.
To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you’re terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to hospice care, you’re agreeing to comfort care (palliative care) instead of care to cure your illness. You also must sign a statement choosing hospice care instead of other benefits Medicare covers to treat your terminal illness and related conditions. Publication 02154
Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include:
any or all of these services:
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Prescription drugs for symptom control or pain relief
- Hospice aide and homemaker services
- Physical therapy services
- Occupational therapy services
- Speech-language pathology services
- Social work services
- Dietary counseling
- Grief and loss counseling for you and your family
- Short-term inpatient care (for pain and symptom management)
- Short term respite care
- Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team medicare.gov/hospice-care
When you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren’t working.
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Medicare won’t cover any of these once your hospice benefit starts:
- Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you’re thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
- Prescription drugs to cure your illness (rather than for symptom control or pain relief).
- Care from any hospice provider that wasn’t set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.
- Room and board. Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
- Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions. medicare.gov/hospice-care
Contact your hospice team before you get any of these services or you might have to pay the entire cost.
Your costs in Original Medicare
- $0 for hospice care.
- You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you’re at home. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it’s covered under Part D Rx
- You may need to pay 5% of the Medicare-approved amount for inpatient respite care.
- Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
Official Medicare #Hospice Publication # 02154
- Video on Hospice
- Palliative Care VIDEO
- Palliative care, which focuses on providing relief from the symptoms and stress of serious illness, offers an extra layer of support. Learn more at chcf.org
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- LA Times – Hospice and caring for spouses 12.22.2014
- Find hospice care
- Los Angeles times opinion on hospice at home doctor-patients-send-home-to-die
- Steve Lopez: After my mother’s disastrous hospice experience, we filed a state complaint. It came to nothing
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- Under 65 ACA/Obamacare Evidence of Coverage see page 82
- A service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain. (2014 ACA Sample EOC Page 166) CA WIC §14059.5
- Compare & Contrast Palliative & Hospice Care NIH.Gov
- Medicare Processing Manual – Hospice Claims 78 pages
- My Jewish Learning.com hospice & palliative care
- Hospice Reform in CA
- SB 664 a moratorium on the department issuing a new license to provide hospice services, unless the department makes a written finding that an applicant for a new license, or with a license application pending on January 1, 2022, has shown a demonstrable need for hospice services in the area where the applicant proposes to operate based on the concentration of all existing hospice services in that area.
- AB 1280 prohibit a hospice provider, employed hospice staff, or an agent for the hospice from paying referral sources for the referral of patients to the hospice. The bill would prohibit a hospice salesperson, recruiter, agent, or employee who receives compensation or remuneration for hospice referrals or admissions from providing consultation on hospice services, hospice election, or informed consent to a patient, patient’s family, or patient’s representative. The bill would require a specified person, including a registered nurse or medical social worker, to complete the election of hospice, informed consent, completed signatures, and counsel on the election of hospice with a patient, patient’s family, or patient’s representative. The bill would require a hospice to provide verbal and written notice of the patient’s rights and responsibilities to the patient or the patient’s representative, in a language and manner the person understands, before providing care.
- Making it easier for dying people to die
California revises the End of Life Option Act. Supporters say the new law removes ‘bureaucratic barriers.’ LA Times
- ‘Large-scale fraud’ and lax oversight plague California’s hospice industry LA Times 3.29.2022
- How to get death certificate if someone dies at home
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