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Medicare Hospice Benefits

Important Facts About Hospice
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Medicare Coverage for Hospice Care.

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To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that youíre terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to hospice care, youíre agreeing to comfort care (palliative care) instead of care to cure your illness. You also must sign a statement choosing hospice care instead of other benefits Medicare covers to treat your terminal illness and related conditions.

Only your hospice doctor and your regular doctor (if you have one) can certify that youíre terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (at a face-to-face meeting) that youíre still terminally ill.

Hospice care is usually given in your home but may also be covered in a hospice inpatient facility. Original Medicare will still pay for covered benefits for any health problems that arenít part of your terminal illness and related conditions, but this is unusual. When you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren't working. Once you choose hospice care, your hospice benefit will usually cover everything you need. For more information: https://www.medicare.gov/coverage/hospice-care

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 team determines that you need inpatient care, they'll make the arrangements for your stay.

When determining eligibility for hospice
, a doctor must certify that the patient is terminally ill, with a life expectancy of six months or less if the disease runs its expected course. The hospice medical director must agree with the doctor's assessment
.

Special Note...

If you start hospice care on or after October 1, 2020, you can ask your hospice provider for a list of items, services, and drugs that theyíve determined arenít related to your terminal illness and related conditions. This list must include why they made that determination. Your hospice provider is also required to give this list to your non-hospice providers or Medicare if requested.

Where you get hospice care

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 team determines that you need inpatient care, they'll make the arrangements for your stay.

If you need to get inpatient care at a hospital, your hospice provider must make the arrangements. The cost of your inpatient hospital care is covered by your hospice benefit, but paid to your hospice provider. They have a contract with the hospital and they work out the payment between them. However, if you go to the hospital and your hospice provider didnít make the arrangements, you might be responsible for the entire cost of your hospital care.


 

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