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Understanding How Hospice Works With Insurance

Accord Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers. If a person does not have coverage through Medicare, Medicaid or a private insurance company, Accord Hospice will work with the person and their family to ensure needed services can be provided.  

Medicare

The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of medical and support services for their life-limiting illness. Hospice care also supports the family and loved ones of the person through a variety of services.

More than 90% of hospices in the United States are certified by Medicare. Eighty percent of people who use hospice care are over the age of 65, and are thus entitled to the services offered by the Medicare Hospice Benefit. This benefit covers virtually all aspects of hospice care with little out-of-pocket expense to the person or family. In addition, most private health plans and Medicaid in 47 States and the District of Columbia cover hospice services.

Sometimes a person’s health improves or their illness goes into remission. If that happens, your doctor may feel that you no longer need hospice care. Also, you always have the right to stop getting hospice care, for any reason. If you stop your hospice care, you will receive the type of Medicare coverage that you had before electing hospice. If you are eligible, you can go back to hospice care at any time.

Coverage

Medicare defines a set of hospice core services, which means that hospices are required to provide these set of services to each person they serve, regardless of the persons insurance.

Medicare covers these hospice services 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

 
You will only have to pay part of the cost for outpatient drugs and inpatient respite care.

Eligibility

You are eligible for Medicare hospice benefits when you meet all of the following conditions:
 

  • You are eligible for Medicare Part A (Hospital Insurance), and
  • Your doctor and the hospice medical director certify that you have a life-limiting illness and if the disease runs its normal course, death may be expected in six months or less to live, and
  • You sign a statement choosing hospice care instead of routine Medicare covered benefits for your illness*, and
  • You receive care from a Medicare-approved hospice program.

*Subject to Medicare guidelines.

Medicare Hospice Benefit Does Not Cover...

Treatment intended to cure your illness.

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 and which ones are not covered under the Medicare Hospice Benefit. The Hospice uses medicine, equipment, and supplies to make you as comfortable as possible. Under the hospice benefit, Medicare won’t pay for treatment where the goal is to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. 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.

Medicaid

Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.

Thirty-two states and the District of Columbia provide Medicaid eligibility to people eligible for Supplemental Security Income (SSI ) benefits. In these States, the SSI application is also the Medicaid application. Medicaid eligibility starts the same months as SSI eligibility.

The following jurisdictions use the same rules to decide eligibility for Medicaid as SSA uses for SSI, but require the filing of a separate application: Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, Utah, Northern Mariana Islands

The following States use their own eligibility rules for Medicaid, which are different from SSA`s SSI rules. In these States a separate application for Medicaid must be filed: Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, Virginia.

How Does a Recipient Qualify?

To qualify a recipient must:
  

  • Have been eligible for an SSI cash payment for at least one month;
  • Still be disabled;
  • Still meet all other eligibility rules, including the resources test;
  • Need Medicaid in order to work; and
  • Have gross earned income that is insufficient to replace SSI, Medicaid, and any publicly funded attendant care. (Refer to Red Book for the "threshold amount" section.)

  The Center for Medicare and Medicaid Services (formerly HCFA) oversees State administration of Medicaid.

 

Coverage While Working

If a recipient`s State provides Medicaid to people on SSI, the recipient will continue to be eligible for Medicaid. Please refer to the general Work Incentives section for more information about SSI work incentives.

Medicaid coverage can continue even it a recipient`s earnings along with other income become too high for a SSI cash payment.


Important Links

Medicaid At-a-Glance

A Compendium of Health and Human Service Technical Assistance Activities Related to the Administration`s Community - Integration Initiative

State Medicaid Contact Information

Medicaid Protection for Working People with Disabilities

Continued Medicaid Eligibility - Section 1619B

Medicaid Buy-In States for Working People with Disabilities Information

Office of Disability, Aging and Long-Term Care Policy (DALTCP) REPORTS




  
   
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Fax (847) 574-0440
                        
                info@accordhospice.com         

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