Who is eligible for hospice care under Medicare? Also, does care have to be provided in the patient's home in order to be covered? What if a patient becomes stable for a while? Can he come and go from hospice care?
You've asked complicated questions. You can get more direct answers by calling 1-800-MEDICARE or 1-800-633-4227. However, I have a brochure from the Center for Medicare Education that answers most of what you asked.
Since 1983, the Medicare Hospice Benefit has enabled millions of terminally ill people and their families to receive end-of-life care that emphasizes comfort, compassion and dignity. This benefit is centered on the belief that each of us has the right to die pain-free and with dignity, and that our families and friends should receive the necessary support to allow us to do so. The focus is on caring, not curing.
Hospice benefits are available to Medicare beneficiaries who:
Have Medicare Part A.
Are certified by their doctor and the hospice medical director as terminally ill and having a life expectancy of six months or less.
Sign a statement choosing hospice care using the Medicare Hospice benefit, rather than curative treatment and standard Medicare covered benefits for their terminal illness.
Enroll in a Medicare-certified hospice program.
Typically, a family member or friend serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff are on call 24 hours a day, seven days a week.
Sometimes a patient does not or cannot reside in a private home. The Medicare Hospice Benefit also reimburses for hospice services that are delivered in freestanding hospice facilities, hospitals, nursing homes and other long-term care facilities. However, the benefit does not cover expenses for room and board.
A patient has the right to stop receiving hospice care at any time, for any reason. If patients choose to stop hospice care, they will automatically go back to receiving all their benefits from Original Medicare or the chosen Medicare-Choice plan.
Occasionally, a terminally ill hospice patient's health improves, or his or her illness goes into remission. A patient's condition may become stable to the point that the hospice team and physician(s) believe the patient cannot be certified as terminally ill and is therefore no longer eligible for continuing benefits. A patient can return to hospice care, as long as the eligibility criteria is met and certification by the physician and hospice team is received.
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