Medicare, Medicaid and Private Insurance

Access to appropriate care is impartial without regard to race, national origin, age, gender, religion, creed, diagnosis, disability, sexual orientation, place of residence within the area served by Hospice, source of payment or the ability to pay for services.

Hospice Benefits under Medicare

The information on this page focuses on Hospice care under original Medicare (Parts A and B). In general, Hospice benefits are the same for participants in Medicare+Choice (M+C) plans. Check with your plan for more details.

Original Medicare covers many services under Hospice care:

• Nursing services on an intermittent basis
• Physician services
• Drugs, including outpatient medications for pain relief and symptom management of Hospice diagnoses
• Physical therapy, occupational therapy and speech-language pathology
• Home care aide services
• Medical supplies and equipment related to the Hospice diagnosis
• Short-term inpatient care, including “respite” care, which occurs when patients are admitted to provide relief for the caregiver (usually a maximum of 5 days)
• Medical social services
• Counseling

A patient may be asked to pay:

• 5% of the cost of outpatient drugs or $5 for each prescription not related to the Hospice diagnosis, whichever is less
• 5% of the original Medicare rate for respite care

Who's eligible for Hospice care under original Medicare?

• Anyone covered by Part A of Medicare
• The patient's physician and the Hospice medical director certify that a patient is terminally ill (a life expectancy of 6 months or less). The patient chooses to receive care from Hospice instead of standard medical benefits.
• Care is provided by a Hospice program certified by Medicare.

Medicare pays benefits for:

• Two 90-day periods
• An unlimited number of 60-day periods, if the patient is re-certified as terminally ill at the beginning of each period

The patient may stop Hospice care at any time and return to cure-oriented care. Any remaining days in a benefit period are forfeited once Hospice care is stopped.

The Medicare Hospice Benefit does not pay for treatment or services unrelated to the terminal illness. Any attending physician charges would continue to be reimbursed in part through Medicare Part B coverage. However, the standard Medicare benefit program still helps pay covered costs necessary to treat an unrelated condition.

Who pays for the extra services at a Hospice House?

Hospice care services continue to be covered for patients who may move into a Hospice House. However, a room and board fee may be required depending on the patient's level of care (acuity needs). If a room and board fee is assessed, it is based on a sliding scale of $0 to a maximum of $120 per day based on the patient's ability to pay.

When beds are available, a Hospice House may also serve as a step-down unit for our Heartbeats program. Patients with end-stage cardiac diagnosis coming onto Hospice from the hospital may also receive attentive care at a Hospice House as they transition to their own home.