Hospice Care Coverage
This document provides a comprehensive, Medicare‑administered guide to hospice care under Part A. It explains that eligible beneficiaries—those with Part A who have a physician‑certified terminal illness with a life expectancy of six months or less and who elect comfort‑focused (palliative) care—receive hospice benefits in two 90‑day periods followed by unlimited 60‑day periods. The guide details what is covered (all hospice‑team‑arranged services, including home, nursing‑home, or inpatient hospice care) and what is excluded (curative treatments, prescription drugs aimed at cure, room and board, outpatient/inpatient hospital services not arranged by the hospice team, and ambulance transport unless related). It outlines patient rights (changing hospice providers once per benefit period, requesting a list of non‑covered items, and receiving an addendum to the Hospice Election Statement). Cost information includes zero cost for approved hospice services, a $5 copayment for outpatient symptom‑management drugs, a possible 5 % copayment for inpatient respite care (capped at the inpatient deductible), and responsibility for room‑and‑board in certain facilities. Provider requirements are clarified: only the hospice physician and the beneficiary’s regular physician can certify terminal status, and recertification is required after six months. The document also notes how Medicare Advantage or other Medicare health plans interact with hospice benefits, where to find Medicare‑approved hospice providers, and links to related resources.
Topics
Eligibility and Election: Certifying Terminal Illness and Choosing Comfort Care
Criteria for Medicare Part A hospice eligibility, including physician certification of a ≤6‑month life expectancy, acceptance of palliative care, and signing the Hospice Election Statement.
Benefit Period Structure: Two 90‑Day Periods Followed by Unlimited 60‑Day Periods
How hospice benefits are organized into initial 90‑day periods and subsequent 60‑day extensions, and the implications for continued coverage.
Covered Services vs. Exclusions: What Medicare Pays for Under Hospice
Comprehensive list of services covered by the hospice benefit (team‑arranged care, inpatient/respite care when authorized) and detailed exclusions (curative treatments, prescription drugs for cure, room and board, non‑team‑arranged hospital/outpatient services, ambulance transport).
Patient Rights and Provider Change Policies
Beneficiary rights to change hospice providers once per benefit period, request non‑covered item lists, and receive addenda to the Election Statement explaining exclusions.
Cost Sharing and Copayments: Out‑of‑Pocket Responsibilities
Zero cost for approved hospice services, $5 copayment for outpatient symptom‑management drugs, up to 5 % (capped at deductible) for inpatient respite care, and potential room‑and‑board charges in facilities.
Provider Certification and Recertification Requirements
Roles of hospice physician and beneficiary’s regular physician in certifying terminal status, and the need for recertification after six months via hospice medical director or face‑to‑face meeting.
Care Settings: Home, Nursing Home, Assisted Living, and Inpatient Hospice Facilities
Where Medicare‑approved hospice care can be delivered, conditions for inpatient hospice or hospital stays, and patient responsibilities for costs if care is outside approved settings.
Interaction with Medicare Advantage and Other Medicare Health Plans
How hospice benefits integrate with Medicare Advantage or other Medicare health plans, ensuring coverage continuity.