Eligibility

Who is Eligible?

Centers for Medicare and Medicaid list eligibility requirements and benefits as following:

Hospice Coverage

Hospice is a comprehensive, holistic program of care and support for terminally ill patients and their families. Hospice care changes the focus to comfort care (palliative care) for pain relief and symptom management instead of care to cure the patient’s illness.

  • They get care from a Medicare-certified hospice
  • Their attending physician (if they have one) and the hospice physician certifies them as terminally ill, with a medical prognosis of 6 months or less to live if the illness runs its normal course
  • They sign an election statement to elect the hospice benefit and waive all rights to Medicare payments for the terminal illness and related conditions

All hospice care and services offered to patients and their families must follow an individualized written plan of care (POC) that meets the patient’s needs. The hospice interdisciplinary group establishes the POC together with the attending physician (if any), the patient or representative, and the primary caregiver.

Items & Services Included in the Hospice Benefit

The Medicare hospice benefit includes these items and services to reduce pain or disease severity and manage the terminal illness and related conditions.

  • Services from a hospice-employed physician, nurse practitioner (NP), or other physicians chosen by the patient
  • Nursing care
  • Medical equipment
  • Medical supplies
  • Drugs to manage pain and symptoms
  • Hospice aide and homemaker services
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Dietary counseling
  • Spiritual counseling
  • Individual and family or just family grief and loss counseling before and after the patient’s death
  • Short-term inpatient pain control and symptom management and respite care

Medicare may pay for other reasonable and necessary hospice services in the patient’s POC. The hospice program must offer and arrange these services

Hospice Levels of Care

Medicare makes payments based on 1 of 4 levels of hospice care:

A patient elects to get hospice care at home and isn’t getting continuous home care. A patient’s home might be a home, a skilled nursing facility (SNF), or an assisted living facility. Routine home care is the level of care provided when the patient isn’t in crisis.

When both of these apply:

  • The patient gets hospice care in a home setting that isn’t an inpatient facility (hospital, SNF, or hospice inpatient unit)
    The care consists mainly of nursing care on a continuous basis at home
  • Patients can also get hospice aide, homemaker services, or both on a continuous basis. Hospice patients can get continuous home care only during brief periods of crisis and only as needed to maintain the patient at home.

A patient elects to get hospice care in an approved inpatient facility for up to 5 consecutive days to give their caregiver a rest.

A patient elects hospice care in an inpatient facility for pain control or acute or chronic symptom management, which can’t be managed in other settings.