WellSpan Home

Medicare Hospice Benefit

Topic Overview

Medicare is a health insurance program for people 65 years of age and older, for some people younger than 65 who have disabilities, and for people with long-term (chronic) kidney failure treated with dialysis or a transplant. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) of the United States government.

The Medicare hospice benefit is described in Part A, which talks about hospital insurance. Part A benefits provide coverage for hospitals, nursing facilities (but not custodial or long-term care), some home health care, and hospice. People (including a spouse) who paid Medicare taxes while they were working are eligible for Part A benefits. A monthly payment, or premium, is not required for Part A benefits.

Eligibility

The Medicare hospice benefit provides coverage for services related to a life-limiting illness. Hospice care is covered under Medicare Part A benefits. You must meet all of the following criteria to be eligible for the Medicare hospice benefit:

  • You must be eligible for Medicare Part A benefits.
  • Your doctor and hospice medical director must certify that you have a life-limiting illness and are likely to live 6 months or less if your illness follows a normal course.
  • You must sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your life-limiting illness. (Medicare will still cover services for any health problem that is not related to your life-limiting illness.)
  • You must receive care from a hospice approved by Medicare.

Covered services

Medicare pays the hospice program a daily (per diem) rate that is intended to fully cover most services related to a life-limiting illness, including:

  • Hospice nursing care in your home. This includes intermittent visits by a nurse to check on your symptoms. Nurses are also available 24 hours a day, 7 days a week to visit if you need help. Live-in nursing care is not covered.
  • Medical supplies and equipment, such as a wheelchair, hospital bed, or incontinence pads.
  • Medicines for symptom control and pain relief. You will have to pay no more than $5 for each prescription drug and other related products.
  • Visits to your doctor to help manage your life-limiting illness.
  • Intermittent homemaker and home health aide services. The service of a live-in homemaker or home health aide is not covered.
  • Physical, occupational, or speech therapy, if needed because of your life-limiting illness.
  • Dietary counseling.
  • Visits from a counselor or social worker.
  • Spiritual care, if desired.
  • Visits from trained volunteers. Volunteers are available on a short-term basis to provide companionship, to help with your care, or to run errands.
  • Short-term respite care so your caregiver can rest or take some time off (you may need to pay a small copayment).
  • Temporary hospitalization, if needed, to help manage symptoms that cannot be controlled at home.
  • Counseling (called bereavement care) for your family, friends, and caregivers following your death.

If your condition changes so that hospice is no longer appropriate, you can get your previous Medicare benefits reinstated. You can also re-apply for hospice benefits at a later time if needed.

For more information

The Centers for Medicare and Medicaid Services (CMS) of the United States government manages the Medicare hospice benefit. You may call toll-free (1-800-633-4227) or visit its Web site at www.cms.gov for more information.

Credits

ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical ReviewerShelly R. Garone, MD - Palliative Medicine

Current as ofOctober 6, 2017


Are you sure you would like to cancel?

All information will be lost.

Yes No ×

About the provider search

This search will provide you with WellSpan Medical Group and Northern Lancaster County (Ephrata) Medical Group primary care physicians and specialists. If we don’t have a WellSpan Medical Group physician to meet your criteria, the search will expand to include community physicians who partner with WellSpan Medical Group physicians through the WellSpan Provider Network or provide care to patients on the Medical Staffs of WellSpan’s Hospitals.

×

Schedule Your Next Appointment Online with MyWellSpan

Use your MyWellSpan patient portal any time to view available appointments, and pick the date and time that best suits your schedule.

Go to MyWellSpan

New to this practice?

If you don't have a WellSpan primary care provider and would like to schedule a new patient appointment with a provider who is accepting patients, just log into your MyWellSpan account, and go to the Appointment Center section. As you progress through the scheduling process, you will be able to see the offices that are accepting new patients in relation to your zip code. If you are not enrolled in MyWellSpan, go to https://my.wellspan.org, call 1-866-638-1842 or speak with a member of the staff at a participating facility to sign up. New patient scheduling not available at all practices/programs.

Already a patient at this practice?

If you already have a relationship with a WellSpan practice, simply log into your account, and go to the Appointment Center section. As you progress through the scheduling process, you will be able to schedule an appointment with any provider or practice that already counts you as a patient. Online scheduling varies by practice/program.

×