Understanding Medicare Hospice Benefits

Hospice care is a difficult program to digest, both from an emotional and financial/practical standpoint. At Regency Nursing Centers statewide, we contract with various Hospice providers to offer our families compassionate and dignified end-of-life care.

Furthermore, our social workers regularly sit with families to discuss the nuances and ramifications of placing their loved one on Hospice Care.

Understanding the specific Medicare Hospice Benefits can be a daunting and overwhelming task. Here is some valuable information in a condensed form and I will also link you to an excellent and informative pamphlet published by Medicare.gov at the end of this article.

Medicare’s hospice benefit covers palliative
and support services for terminally ill
beneficiaries who have a life expectancy
of six months or less if the terminal illness follows its     hospice
normal course. A broad set of services is included, such as nursing care; physician services; counseling and
social worker services; aide and homemaker services;
short-term hospice inpatient care (including respite
care); drugs and supplies; physical, occupational,
and speech therapy; and bereavement services for the
patient’s family.

Beneficiaries must “elect” hospice care for defined
benefit periods; in doing so, they agree to forgo
Medicare coverage for conventional treatment of the
terminal illness. Under current policy, the first hospice
benefit period is 90 days. For a beneficiary to initially
elect hospice, two physicians—a hospice physician and
the beneficiary’s attending physician—are generally
required to certify that the beneficiary has a life
expectancy of six months or less if the illness runs its
normal course. If the patient’s terminal illness continues
to engender the likelihood of death within six months,
the patient can be recertified for another 90 days. After
the second 90-day period, the patient can be recertified
for an unlimited number of 60-day periods, as long as
he or she remains eligible. For recertification, only the
hospice physician has to certify that the beneficiary’s
life expectancy is six months or less. Beneficiaries can
transfer from one hospice to another once during a
hospice benefit period and can disenroll from hospice at
any time.

Under the Medicare hospice benefit, there are four
types of care: routine home care, continuous home
care, general inpatient care, and inpatient respite care.

Routine home care, which can be provided in a variety
of settings—including the patient’s home, a nursing
facility, an assisted living facility, and other types of
facilities—makes up more than 97 percent of hospice
days. Medicare makes a flat payment per day (adjusted for differences in wage rates across
geographic areas) for routine home care, regardless of
whether the hospice staff visits the patient each day.
Beneficiary cost sharing for hospice services is
minimal. There is no cost sharing other than for
prescription drugs and inpatient respite care. For
prescriptions, hospices may charge 5 percent
coinsurance (not to exceed $5) for each prescription
furnished outside the inpatient setting. For inpatient
respite care, beneficiaries may be charged 5 percent of
Medicare’s respite care payment per day. In practice,
hospices do not generally charge or collect these
copayments from Medicare beneficiaries.

For an excellent pamphlet on this topic, click here.

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