What Are The Medicaid Requirements For Hospice
- A hospice plan of care must be established before services are provided.
- A hospice physician must certify that the individual is terminally ill.
- The individual must complete a hospice election statement.
- The individual must elect the hospice benefit by completing an election statement.
- A specific hospice provider must be selected and will serve as the individuals care team.
- The individual must waive all Medicaid services to cure the terminal condition.
How Do You Start Hospice Care On Medicare
You may be referred to hospice care by your primary physician, specialist, or someone in your family or community. Whether you are in a facility or living at home, your physician and a hospice physician will need to verify that you qualify for hospice care before an agency can fully admit you for care.
When you agree to hospice care, youre acknowledging that you choose comfort care instead of curative care. You must sign a statement choosing hospice care instead of other benefits Medicare covers to treat your terminal illness and related conditions.
Most often, your doctor or social services staff at a nursing facility will give you a list of hospices in your area, so you can choose which agency you prefer. You may receive recommendations from others in your community. You can search for and compare Medicare-certified hospice providers in your area here.
If youre enrolled in a Medicare Advantage Plan and want to start hospice care, ask your plan to help you locate a Medicare-approved hospice provider in your area.
Room And Board At A Nursing Facility
The Medicare Hospice Benefit doesnt cover room and board at nursing facilities. However, Medicare covered hospice services can be administered wherever that individual lives, even if it is in a nursing facility. If a patient is eligible for Medicaid, the Medicaid benefits may pay for room and board.
Don’t Miss: Why Is My Medicare So Expensive
Who Is Eligible For Hospice Care Under Medicare
Anyone eligible for Medicare Part A is eligible for Medicare-covered hospice care. To qualify for Part A, you must be 65 or older and meet one of the following requirements:
- You receive Social Security or Railroad Retirement Board benefits.
- You are eligible for Social Security or Railroad Retirement Board benefits but arent receiving them.
- You or your spouse paid Medicare taxes during government employment.
If youre under 65, you can still qualify for Medicare if you receive disability benefits or have End-Stage Renal Disease.
Does Medicaid Cover Hospice
- At least 210 days of hospice care.
- A hospice care team including doctors, nurses, and nurse practitioners.
- Home health aides and homemaker services.
- Rental or purchase of medical appliances and supplies.
- Physical therapy, occupational therapy, and speech-language pathology services.
- Prescriptions for pain relief and management.
- Grievance and counseling services for the hospice patient and their family members.
- Short-term inpatient or respite care services.
Did You Know: Patients can still see their regular physician if the physician is elected to aid in supervising the patients hospice care.
Don’t Miss: Do You Have To Take Medicare
What You’ll Have To Pay
You will have a small copay of $5 for medications, although some hospice organizations waive this copay. You may have a 5% coinsurance for the cost of any respite care . If you have a Medigap plan, it will cover some or all of your out-of-pocket costs for hospice.
You will pay the Medicare Part B deductible and coinsurance for any physician services you receive from a doctor that isnt working for your hospice organization. And if you receive inpatient hospital care that’s unrelated to your terminal condition, you’ll be responsible for the normal Part A deductible .
You’ll need to continue paying any Medicare premiums you were paying before you signed up for hospice. This includes the Medicare Part B premium, as well as a premium for Part D and/or a Medigap policy or Medicare Advantage plan, if you have any of those plans.
Can I Get Hospice Care In An Assisted Living Residence
Fredrick P. Niemann Esq.
New Jerseys licensure law allows hospice care in any kind of residence. Let the hospice staff know of the living arrangements, and they will work with the staff at the assisted living residence.
If you would like to speak to a NJ hospice attorney, contact Fredrick P. Niemann, Esq. toll-free at 376-5291 or email him at to schedule a consultation about your particular needs. He welcomes your calls and inquiries and youll find him very approachable and easy to talk to.
Also Check: How To Compare Medicare Supplement Plans
Top Rated Assisted Living Communities By City
Seniors enrolled in Medicare Advantage plans are covered for hospice care through Original Medicare, as long as the hospice provider is Medicare-approved. The costs of hospice are covered by Original Medicare, and seniors can decide to opt out of their Medicare Advantage plan once the hospice benefit begins.
You May Like: What Medications Are Covered By Medicare
Hospice Services Covered By Medicare
Both the patient and their family members get benefit from the range of services provided by hospice providers. To make sure the patient understands, it is important to be aware that services like these could be included in the patients overall plan of care and are at least partially covered by Medicare.
Original Medicare covers a wide range of services, supplies, and prescriptions related to the illness that prompted you to seek hospice care, such as:
- Doctor and nursing services.
- Grief and loss counseling for both the patient and their family
- Short-term inpatient care for pain and symptom management
- Social work services
- Short-term respite care to give your caregiver a break if you are being cared for at home.
If you are receiving hospice care, Medicare Part A will continue to cover any other non-terminal illnesses or conditions you may have. You can also keep your Medicare Advantage plan while receiving hospice care if you want to continue receiving additional coverage.
You May Like: How To Apply For Medicare In Illinois
Which Parts Of Medicare Cover Hospice Care
There are many different parts Medicare. Each part provides coverage for different items and services. Here is a breakdown of the role each part of Medicare may play in covering your hospice care:
- Medicare Part A.Part A pays for hospital costs, should you need to be admitted to care facility for your symptoms or to give your caregivers a short break.
- Medicare Part B.Part B covers outpatient medical and nursing services, medical equipment, and other treatment services.
- Medicare Part C. If you have a Medicare Advantage plan, it will remain in effect as long as youre paying premiums, but you wont need them for your hospice expenses. Original Medicare pays for those. Your Medicare Part C plans can still be used to pay for treatments that are not related to the terminal illness or arent covered by original Medicare.
- Medicare supplement .Medigap plans can help with costs unrelated to the terminal illness. You wont need these benefits to help cover hospice expenses, since those are paid for by original Medicare.
- Medicare Part D. Your Part D prescription drug coverage will still be in effect to help you pay for medications that are unrelated to the terminal illness. Otherwise, medications to help treat symptoms or manage the pain of a terminal illness are covered through your original Medicare hospice benefit.
Original Medicare pays for a wide range of services, supplies, and prescriptions related to the illness that caused you to seek hospice care, including
What Costs Are Covered
Original Medicare covers all costs related to the terminal illness and related conditions, including doctors fees, nursing care, wheelchairs, catheters, physical therapy and grief counseling. There are no deductibles. In some cases, there may be a small co-payment for medication to help manage pain or for inpatient respite care if the family needs a rest.
Medicare also covers inpatient care at a hospital if the hospice provider deems it necessary. The hospital stay must be arranged by the hospice provider, and the cost is reimbursed to the hospice provider.
Read Also: How Much You Pay For Medicare
How Long Will Medicare Pay For Hospice Care
Hospice care is for patients who have six months or less to live. However, estimating someones life expectancy is not an exact science. Therefore, the Medicare hospice benefit is broken down into two 90-day benefit periods that are followed by an unlimited number of 60-day benefit periods .
A terminally ill patient can continue receiving covered hospice care as long as their hospice physician continues to certify that they have six months or less to live. Some people retain their terminal status yet survive much longer than expected and remain under hospice care for many months or even years.
A patient must be certified as having six months left to live before the services can begin and be recertified at the start of each new benefit period. A face-to-face meeting with a hospice doctor is required prior to the start of their third benefit period to recertify their eligibility. These face-to-face recertification meetings are then required prior to each subsequent 60-day benefit period and must take place no earlier than 30 days before the new benefit period begins.
Due to the ongoing COVID-19 pandemic, keep in mind that the Centers for Medicare and Medicaid Services has temporarily eased some regulations, allowing telehealth services to be used in place of face-to-face encounters where appropriate. This includes hospice recertification visits.
How Do You Pay For Hospice Care
For those not eligible for Medicare or Medicaid, payment for hospice can come from private insurance or an HMO, since these also include a hospice benefit.
Hospices employ financial specialists to help families who do not qualify for federal assistance and do not have insurance find available resources. The payment options for these families include self-pay and charitable organizations.
Facing a terminal illness brings with it many concerns. Paying for end-of-life care shouldnt be one of them.
Recommended Reading: Does Medicare Cover International Medical Emergencies
How Much Does Hospice Care Cost With Medicare
How much hospice care costs depends on the type of illness and how early patients enter hospice. In 2018, the Society of Actuaries estimated that hospice patients with cancer received Medicare Part A and Part B benefits totaling around $44,030 during the last 6 months of their lives.
That figure includes the cost of inpatient hospital treatments, in addition to at-home hospice care.
The good news is that there are no deductibles for hospice care under Medicare.
Some prescriptions and services may have copays. Prescriptions for pain medications or symptom relief may carry a $5 copay. There may be a 5 percent copay for inpatient respite care if you are admitted to an approved facility, so your caregivers can rest.
Other than those instances, you wont have to pay for your hospice care.
Who Is Eligible For Medicare Hospice Benefits
Youâre generally eligible for Medicare hospice benefits when you meet the following conditions:
- You have Medicare Part A .
- Your doctor and the hospice medical director certify that you have a life-limiting illness and if the illness runs its normal course, death may be expected within six months or less.
- You sign a statement choosing hospice care instead of curative care for your illness.
- You receive care from a Medicare-approved hospice program.
You May Like: Is My Medicare Number My Social Security Number
How Much Does Medicare Pay For Hospice
- Up to a $5 copayment per prescription for outpatient drugs to relieve pain and manage terminal illness-related symptoms.
- Five percent of the Medicare-approved cost for inpatient respite care.
Did You Know: If a prescription is not covered under the patients Medicare hospice plan, ask a hospice care team member to inquire if the medication is covered under Medicare Part D. If you or your loved one needs a prescription drug plan, visit our list of the best Medicare Part D plans.
Hospice And Medicaid Restrictions
The Medicaid hospice benefit is a provision of the state, and each state may cover different end-of-life care services. Most states model their coverage on the federal Medicare model, which restricts certain treatments and services including:
- Curative treatment: The Medicaid hospice benefit requires patients discontinue curative treatment to begin hospice care. The one exception to this is for patients under the age of 21 who may be able to continue curative treatment while receiving comfort care.
- Care not provided or arranged by the selected hospice organization: Once a patient begins receiving hospice services, all care for their terminal illness will be coordinated by the hospice organization.
- Room and board: The Medicaid hospice benefit does not cover room and board fees if the patient resides at a nursing home or other facility.
- Skilled nursing care: If a patient has received skilled nursing care for their terminal illness, the Medicaid hospice benefit will not cover hospice services until the following day.
- Inpatient respite care: Patients may be responsible for paying 5% of the Medicaid-approved amount for short-term in-patient respite care.
You May Like: Who Gets Medicare Part D
Your Hospice Care Costs With Medicare
Most Medicare beneficiaries pay little to nothing for hospice care. In some situations, the following small out-of-pocket copays may be necessary for certain items and services:
- Prescription co-pays.A patient will pay no more than $5 for each prescription drug and other similar products they need for pain relief and symptom control. If a specific medication is not covered by the hospice benefit, the hospice provider will contact the patients Part D prescription drug plan to inquire about covering it.
- Five percent of the Medicare-approved cost for inpatient respite care.Medicare negotiates fixed rates with doctors and suppliers who accept assignment. For example, if the approved cost is $100 per day for inpatient respite care, then the patient will only be responsible for paying $5 per day.
Original Medicare will cover everything a patient needs related to their terminal illness, even if they are enrolled in a Medicare Advantage Plan or have a Medigap policy. If a senior on hospice wishes to remain enrolled in their Advantage Plan and make use of medical benefits and services unrelated to their terminal illness, then they will need to continue paying their premiums. Medigap policies typically provide additional coverage for things like prescription drugs and respite care for patients while they are receiving hospice care.
Is Hospice Care Available Through Medicaid
Yes. New Jersey established a Medicaid Hospice Benefit in 1992. Its services are virtually identical to those of Medicare. If you are eligible for Medicaid, let your hospice know as soon as possible, preferably before admission.
Be aware, however, that the federal government does not allow Medicaid recipients to receive two kinds of Medicaid benefit at once.
Hospice is a Medicaid waiver program. Admission to hospice through the Medicaid Hospice Benefit may disqualify a recipient from continuing other Medicaid benefits such as CCPED. You will not risk your existing Medicaid benefits by discussing this issue openly with a hospice social worker.
Many Medicaid hospice patients receive their hospice services in nursing homes where they live. Their Medicaid Hospice Benefit covers both the hospice services and the room and board services provided at the nursing home.
Recommended Reading: Will Medicare Pay For In Home Physical Therapy
What Hospice Services Are Covered By Medicare
Hospice care encompasses a wide variety of services designed to make the patients final months more comfortable:
- Doctor visits
- Spiritual care and counseling
- Grief counseling for both the patient and their family
In general, services will be covered as long as they are provided to improve quality of life rather than treat the illness. Hospice care is normally given to those with a life expectancy of six months or less, but Medicare will cover hospice care as long as its deemed necessary by your hospice doctor.
Medicare covers hospice care within benefit periods. The first two hospice benefit periods last for 90 days each. If care is still needed after 180 days, you will be covered for an indeterminate number of 60-day benefit periods. Again, youre covered for hospice care as long as your hospice doctor certifies that its needed.
Is Inpatient Hospice Covered By Medicare
The Medicare Hospice Benefit is comprehensive coverage that pays for 100% of your hospice services in the hospice plan of care, including a team of professionals physicians, nurses, social workers/ bereavement counselors, spiritual support counselors, certified home health aides plus, medication, equipment, supplies, and inpatient services, if necessary. Please note: you may be responsible for a small co-payment.
Also included under the Medicare Hospice Benefit are the four levels of hospice care, and inpatient hospice is one of those four levels. Medicare will pay for inpatient hospice care for patients who have Medicare Part A or Part C and meet the following conditions:
- Your regular doctor and the hospice medical director certify that you have a life expectancy of six months or less.
- You accept hospice care instead of care to cure your terminal illness.
- You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness and related conditions.
Hospice Care
Also Check: How Much Is Medicare A And B
S Of Medicare And Hospice Coverage
Medicare is broken down into different parts: A, B, C, D, and Medigap. To qualify for the hospice-care benefit from Medicare, you need Medicare Part A, which covers hospital insurance and all other conditions. Medicare typically pays your hospice provider for your hospice care and theres no deductible, but youll pay the remaining cost of monthly Medicare Part A or Medicare Part B premiums.
Medicare Part A covers most medically necessary hospital, skilled nursing facility, home health, and hospice care treatments, and also provides caregivers with respite. Under Medicare Part A, youll need to meet specific conditions certified by a hospice doctor and regular doctor.
- Your hospice doctor and regular doctor must certify that you are terminally ill and expected to live six months or fewer.
- You agree to accept palliative or comfort care instead of curing your illness.
- You sign a statement accepting hospice care instead of other Medicare treatments for terminal illness.
Medicare Part B provides outpatient and medical coverage, which includes certain doctors services, outpatient care, medical supplies, x-rays, mental health care and some home health, and other preventative services.
Medicare Part D covers outpatient prescription-drug insurance and is provided only through private insurance companies with government contracts. This coverage will also help you pay for prescriptions not related to your terminal illness.
