Your hospice benefit covers care for your terminal illness and related conditions. Once you start getting hospice care, your hospice benefit should cover everything you need related to your terminal illness, even if you remain in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan.
How your hospice benefit works
If you qualify for hospice care, you and your family will work with your hospice provider to set up a plan of care that meets your needs. For more specific information on a hospice plan of care, call your state hospice organization. Visit Medicare.gov/contacts, or call 1-800-MEDICARE (1-800-633-4227) to find the number for your state hospice organization. TTY users can call 1-877-486-2048. You and your family members are part of a team that may also include:
■ Nurses or nurse practitioners
■ Social workers
■ Physical and occupational therapists
■ Speech-language pathologists
■ Hospice aides
In addition, a hospice nurse and doctor are on-call 24 hours a day, 7 days a week, to give you and your family support and care when you need it. A hospice doctor is part of your medical team. You can also choose to include your regular doctor, a nurse practitioner, or a physician’s assistant on your medical team as the attending medical professional. The hospice benefit allows you and your family to stay together in the comfort of your home, unless you need care in an inpatient facility. If your hospice provider decides you need inpatient hospice care, your hospice provider will make the arrangements for your stay.
Who’s eligible for the hospice benefit
If you have Medicare Part A (Hospital Insurance) AND meet all of
these conditions, you can get hospice care:
■ Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (you’re expected to live 6 months or less).
■ You accept palliative care (for comfort) instead of care to cure your illness.
■ You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
Note: Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have 6 months or less to live.
What Medicare Won’t
Medicare won't cover any of these once your hospice benefit starts:
Treatment intended to cure your terminal illness and/or related conditions. 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.
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.
Important facts about hospice
Your doctor and the hospice team will work with you and your family
to set up a plan of care that meets your needs. Your plan of care
includes hospice services that Medicare covers. For more specific
information on a hospice plan of care, call your area hospice
If you qualify for hospice care, you’ll have a specially trained team and support staff available to help you and your family cope with your illness. You and your family members are the most important part of the team.
Other people on the hospice team may include:
In addition, a hospice nurse and doctor are on-call 24 hours a day, 7 days a week to give you and your family support and care when you need it.
A hospice doctor is part of your
medical team. Your regular doctor or a nurse practitioner
can also be part of this team as the attending medical professional
to supervise your care. However, only your regular doctor (not a
nurse practitioner that you’ve chosen to serve as your attending
medical professional) and the hospice medical director can certify
that you’re terminally ill and have 6 months or less to live.
The hospice benefit allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility. If the hospice team determines that you need inpatient care, the hospice team will make the arrangements for your stay.
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