Blue Ridge Hospice - Hospice Medicare Benefit

The Hospice Medicare Benefit (HMB), initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of non-curative medical and support services. Hospice care also supports the patient's family and loved ones through a variety of services, enhancing the value of the Medicare Hospice Benefit.

The HMB is an option under the array of other Medicare covered services offered to eligible persons. Individuals must have been diagnosed as terminally ill and have a medically predictable prognosis of six months or less. If patients meet the admission criteria, they may elect the Hospice benefit, thereby waiving other Medicare benefits except those which apply to conditions other than the terminal illness (e.g., a broken hip) and the services of the attending physician.

More information about Medicare Hospice Benefits can be found in the Centers for Medicare & Medicaid Services (CMS) (formerly the Health Care Financing Administration - HCFA) online publication. The HCFA is part of the U.S. Department of Health and Human Services. A downloadable Adobe PDF document (PDF/79k) about the Hospice Medicare Benefit is provided by the Medicare website.

Medicare covers these hospice services associated with a hospice diagnosis and pays nearly all of their costs:

Doctor services
Nursing care
Medical equipment (like wheelchairs or walkers)
Medical supplies (like bandages and catheters)
Drugs for symptom control and pain relief
Short-term care in the hospital, including respite and inpatient for pain and symptom management
Home health aide and homemaker services
Physical and occupational therapy
Speech therapy
Social work services
Dietary counseling
Grief support to help you and your family

The covered services must be provided by a hospice that meets specified conditions of participation and has been duly certified as a Medicare provider by the Health Care Financing Administration. The type and scope of services provided are determined by the hospice interdisciplinary team (composed of the attending physician, hospice nurse, social worker, volunteer and other members as necessary) and aimed at the "management of the terminal illness and related conditions." The level of care being provided is re-evaluated on a continuing basis to ensure appropriateness to the patient and family's needs.

Some other HMB provisions include:

No co-payment for medical equipment and supplies
No deductible for acute inpatient care
Bereavement care for the family up to one year following the patient's death
Traditional "homebound" restrictions do not apply
Traditional intermittent and skilled care restrictions for home care do not apply
Traditional "comfort item" restrictions are waived

For further information concerning the Hospice Medicare Benefit, please contact Blue Ridge Hospice.

Respite Care and Medicare

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 who takes care of you every day, like a family member. Sometimes your caregiver needs 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 residential facility, hospital, or nursing home.

The Medicare Hospice Benefit Does Not Cover the Following:

Treatment intended to cure your terminal illness.
As a hospice patient, you will receive comfort care to help manage symptoms related to your illness. Comfort care includes medications for symptom control and pain relief, physical care, counseling, and other hospice services. Medications not directly related to your hospice diagnosis are not covered under the Medicare Hospice Benefit. Hospice team members will consult with the hospice physician and will inform you and your family which drugs and/or medications are covered under the Medicare Hospice Benefit. Hospice uses medicine, equipment, and supplies to make you as comfortable and pain-free as possible. Under the hospice benefit, Medicare won’t 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 receive the “traditional” Medicare coverage you had before electing hospice.
Care from another provider that is the same care that you are getting from your hospice.
All care that you receive for your illness must be given by your hospice team. You can’t get the same type of care from a different provider unless you change your hospice provider.
Nursing Home Room and Board Room and board aren’t covered by Medicare.
You may receive hospice services wherever you live, even in a nursing home, however, the Medicare Hospice Benefit does not pay for nursing home room and board.

What will I have to pay for hospice care?

Medicare pays the hospice for your hospice care.

You will have to pay:

You can stay in a Medicare-approved hospital or nursing home up to five days each time you get respite care. There is no limit to the number of times you can get respite care.

Can I keep my Medicare health plan?

Yes. You should use your Medicare health plan (like the Original Medicare Plan or a Medicare + Choice Plan) to get care for any health problems that aren’t related to your terminal illness. You may be able to receive care from your own doctor, who isn’t 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 or the co-payment.