| Medicare Services |
Covered |
| Doctor Services |
X |
| Nursing care |
X |
| Medical Equipment (such as wheel chairs or walkers) |
X |
| Medical supplies (such as bandages and catheters) |
X |
|
Drugs for symptom control and pain relief |
X |
|
Short-term care in hospital, including respite care |
X |
| Physical and occupational therapy |
X |
| Speech therapy |
X |
| Social worker services |
X |
| Dietary counseling |
X |
|
Counseling to help you and your family with grief and loss |
X |
You will only have to pay part of the cost for outpatient drugs and inpatient respite care (see section on "What will I have to pay for hospice care?)
What is Respite Care?
Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. As a hospice patient, you may have one person that takes care of
you every day. That person might be a family member. Sometimes they need someone to take care of you for a short time while they do other things that need to
be done. During a period of respite care, you will be cared for in a Medicare-approved facility, such as a hospice facility, hospital or nursing home ( see page 6) .
What is not covered by Medicare?
The care that you get for your terminal illness must be from a hospice. When you choose hospice care, Medicare will not pay for:
Treatment to cure your terminal illness.
As a hospice patient, you can get comfort care to help you cope with your illness, not cure it. Comfort care includes drugs for symptom control and pain relief, physical care, counseling, and other hospice services. Hospice uses medicine, equipment, and supplies to make you as comfortable and pain-free as possible. Medicare will not pay for treatment to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. As a hospice patient, you always have the right to stop getting hospice care and go back to your regular doctor or health plan.
Care from another hospice that was not set up by your hospice.
You must get hospice care from the hospice provider you chose. You cannot get hospice care from another hospice provider, unless you change your hospice provider.
Care from another provider that is the same care that you must get from your hospice.
All care that you get for your terminal illness must be given by your hospice team. You cannot get the same type of care from a different provider unless you change your hospice provider.
What will I have to pay for hospice care?
Medicare pays the hospice for your hospice care. You will have to pay:
No more than $ 5 for each prescription drug and other similar products: The hospice can charge up to $ 5 for each prescription for outpatient drugs or other similar products for pain relief and symptom control.
(WAIVED BY SJH HOSPICECARE )
5% of the Medicare payment amount for inpatient respite care: For example, if Medicare pays $ 100 per day for inpatient respite care, you will pay $ 5 per day. You can stay in a Medicare-approved hospital or nursing home up to 5 days each time you get respite care. There is no limit to the number of times you can get respite care. The amount you pay for respite care can change each year.
(WAIVED BY SJH HOSPICECARE)
Can I keep my Medicare health plan?
Yes. You should use your Medicare health plan ( like the Original Medicare Plan or a Medicare managed care plan) to get care for any health problems that are not related to your terminal illness. You may be able to get this care from your own doctor who is not a part of the hospice, or from the hospice doctor. When you use your Medicare health plan, you must pay the deductible and coinsurance amounts ( if you have the Original Medicare Plan) , or the copayment ( if you have a Medicare managed care plan) . For more information about Medicare health plans, including deductibles, coinsurance, and co-payments, look in your Medicare & You handbook. If you do not have the Medicare handbook, you can get a free copy by calling
1-800-MEDICARE ( 1-800-633-4227) .
Important information about Medicare Supplemental Insurance: If you are in the Original Medicare Plan, you may have a Medicare Supplemental Insurance or Medigap policy. Your Medigap policy still helps to cover the costs for the care of health problems that are not related to your terminal illness. Call your insurance company for more information. You can also call 1-800-MEDICARE ( 1-800-633-4227) and ask for a free copy of the Guide to Health Insurance for People with Medicare . This guide will give you more information on using Medigap policies.
How long can I get hospice care?
You can get hospice care as long as your doctor certifies that you are terminally ill and probably have less than six months to live. Even if you live longer than six months, you can get hospice care as long as your doctor recertifies that you are terminally ill.
Hospice care is given in periods of care. As a hospice patient, you can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods. At the start of each period of care, your doctor must certify that you are terminally ill in order for you to continue getting hospice care. A period of care starts the day you begin to get hospice care. It ends when your 90 or 60-day period is up. If your doctor recertifies that you are terminally ill, your care continues through another period of care.
As a hospice patient, why would I stop getting hospice care?
Sometimes a terminally ill patient s health improves or their illness goes into remission. If that happens, your doctor may feel that you no longer need hospice care and will not recertify you at that time. Also, as a hospice patient you always have the right to stop getting hospice care, for whatever reason. If you stop your hospice care, you will get your health care from your Medicare health plan, ( like the Original Medicare Plan or a Medicare managed care plan) . If you are eligible, you can go back to hospice care at any time.
As a hospice patient, you always have the right to stop getting hospice care and go back to your regular doctor or health plan.
Example:
Mrs. Jones is a cancer patient who received hospice care for two 90-day periods of care. Mrs. Jones cancer went into remission. At the start of her 60-day period of care, Mrs. Jones and her doctor decided that, due to her remission, she would not need to return to hospice care at that time. Mrs. Jones doctor told her that if she becomes eligible for hospice, she may be recertified and can return to hospice care.
Can I change the hospice provider I get care from?
As a hospice patient, you have the right to change hospice providers only once during each period of care.
What will I have to pay for hospice care?
Medicare pays the hospice for your hospice care. You will have to pay:
No more than $ 5 for each prescription drug and other similar products: The hospice can charge up to $ 5 for each prescription for outpatient drugs or other similar products for pain relief and symptom control.
(WAIVED BY SJH HOSPICECARE)
5% of the Medicare payment amount for inpatient respite care: For example, if Medicare pays $ 100 per day for inpatient respite care, you will pay $ 5 per day. You can stay in a Medicare-approved hospital or nursing home up to 5 days each time you get respite care. There is no limit to the number of times you can get respite care. The amount you pay for respite care can change each year.
(WAIVED BY SJH HOSPICECARE)
Can I keep my Medicare health plan?
Yes. You should use your Medicare health plan ( like the Original Medicare Plan or a Medicare managed care plan) to get care for any health problems that are not related to your terminal illness. You may be able to get this care from your own doctor who is not a part of the hospice, or from the hospice doctor. When you use your Medicare health plan, you must pay the deductible and coinsurance amounts ( if you have the Original Medicare Plan) , or the copayment ( if you have a Medicare managed care plan) . For more information about Medicare health plans, including deductibles, coinsurance, and copayments, look in your Medicare & You handbook. If you do not have the Medicare handbook, you can get a free copy by calling
1-800-MEDICARE ( 1-800-633-4227) .
Important information about Medicare Supplemental Insurance: If you are in the Original Medicare Plan, you may have a Medicare Supplemental Insurance or Medigap policy. . Your Medigap policy still helps to cover the costs for the care of health problems that are not related to your terminal illness. Call your insurance company for more information. You can also call 1-800-MEDICARE ( 1-800-633-4227) and ask for a free copy of the Guide to Health Insurance for People with Medicare . This guide will give you more information on using Medigap policies.
How long can I get hospice care?
You can get hospice care as long as your doctor certifies that you are terminally ill and probably have less than six months to live. Even if you live longer than six months, you can get hospice care as long as your doctor recertifies that you are terminally ill.
Hospice care is given in periods of care. As a hospice patient, you can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods. At the start of each period of care, your doctor must certify that you are terminally ill in order for you to continue getting hospice care. A period of care starts the day you begin to get hospice care. It ends when your 90 or 60-day period is up. If your doctor recertifies that you are terminally ill, your care continues through another period of care.
Can I change the hospice provider I get care from?
As a hospice patient, you have the right to change hospice providers only once during each period of care.