medicare hospice benefits 2012

8/22/2019 Medicare Hospice Benefits 2012

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This official governmentbooklet includes information

about Medicare hospice benefits:

Who is eligible for hospice care

What services are included

How to find a hospice program

Where to get more information


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WelcomeChoosing hospice care is a difficult decision. Te inormation inthis booklet and the support given by a doctor and trained hospicecare team can help you choose the most appropriate health careoptions or someone who is terminally ill.

Whenever possible, include the person who may need hospice carein all health care decisions.

Medicare Hospice Benefits isnt a legal document. Official MedicareProgram legal guidance is contained in the relevant statutes,regulations, and rulings.

Te inormation in this booklet was correct when it was printed.Changes may occur afer printing. Visit www.medicare.gov, orcall 1-800-MEDICARE (1-800-633-4227) to get the most currentinormation. Y users should call 1-877-486-2048.
http://www.medicare.gov/http://www.medicare.gov/


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Table of Contents

Hospice care

Medicare hospice benefits

How hospice works

What Medicare covers

Respite care

What Medicare wont cover

What you pay for hospice care

Hospice care if youre in a Medicare Advantage Plan or other Medicare health plan

Care for a condition other than your terminal illness

Information about Medicare Supplement Insurance (Medigap) policies

How long you can get hospice care

Stopping hospice care

Your Medicare rightsChanging your hospice provider

Finding a hospice program

For more information

Definitions

State Hospice Organizations
http://-/?-http://-/?-http://-/?-http://-/?-


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Hospice care

Hospice is a program o care and support or people who are

terminally ill. Here are some important acts about hospice: Hospice helps people who are terminally ill live comortably.

Te ocus is on comort, not on curing an illness.

A specially trained team o proessionals and caregivers provide careor the whole person, including his or her physical, emotional,social, and spiritual needs.

Services may include physical care, counseling, drugs, equipment,and supplies or the terminal illness and related condition(s).

Care is generally provided in the home. Hospice isnt only or people with cancer.

Family caregivers can get support.

Medicare hospice benefits

You can get Medicare hospice benefits when you meet allo theollowing conditions:

Youre eligible or Medicare Part A (Hospital Insurance).

Your doctor and the hospice medical director certiy that youreterminally ill and have 6 months or less to live i your illness runs itsnormal course.

You sign a statement choosing hospice care instead o otherMedicare-covered benefits to treat your terminal illness. (Medicarewill still pay or covered benefits or any health problems that arentrelated to your terminal illness.)

You get care rom a Medicare-approved hospice program.


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How hospice works

Your doctor and the hospice team will work with you and your amily

to set up a plan o care that meets your needs. Your plan o care includeshospice services that Medicare covers. For more specific informationona hospice plan o care, call your stateor national hospice organization.

I you qualiy or hospice care, you will have a specially trained teamand support staff available to help you and your amily cope with yourillness.

You and your amily members are the most important part o the team.

Your team may also include some or all o the ollowing people: Doctors

Nurses

Counselors

Social workers

Physical and occupational therapists

Speech-language pathologists

Hospice aides

Homemakers Volunteers

In addition, a hospice nurse and doctor are on-call 24 hours a day,7 days a week to give you and your amily support and care when youneed it.

A hospice doctor is part o your medical team. Your regular doctoror a nurse practitioner can also be part o this team as the attendingmedical proessional to supervise your care. However, only your regular

doctor (not a nurse practitioner that youve chosen to serve as yourattending medical professional)and the hospice medical director cancertiy that youre terminally ill and have 6 months or less to live.

Te hospice benefit allows you and your amily to stay together in thecomort o your home unless you need care in an inpatient acility. I thehospice team determines that you need inpatient care, the hospice teamwill make the arrangements or your stay.


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What Medicare covers

You can get a one-time only hospice consultation with a hospice medical

director or hospice doctor to discuss your care options and pain and symptomsmanagement. You dont need to choose hospice care to take advantage o thisconsultation service.

Medicare will cover the hospice care you get or your terminal illness, but thecare you get must be rom a Medicare-approved hospice program.

Important:Medicare will still pay or covered benefits or any health problemsthat arent related to your terminal illness, such as care or an injury.

Medicare covers the ollowing hospice services when theyre needed tocare or your terminal illness and related condition(s):

Doctor services

Nursing care

Medical equipment (such as wheelchairs or walkers)

Medical supplies (such as bandages and catheters)

Drugs or symptom control or pain relie (may need to pay a small copayment

Hospice aide and homemaker services

Physical and occupational therapy

Speech-language pathology services

Social worker services

Dietary counseling

Grie and loss counseling or you and your amily

Short-term inpatient care (or pain and symptom management)

Short-term respite care(may need to pay a small copayment)

Any other Medicare-covered services needed to manage your pain and other

symptoms related to your terminal illness, as recommended by your hospiceteam

Respite care

You can get inpatient respite care in a Medicare-approved acility (such as ahospice inpatient acility, hospital, or nursing home) i your usual caregiver (suchas a amily member) needs a rest. You can stay up to 5 days each time you getrespite care. You can get respite care more than once, but it can only be provided

on an occasional basis.

Highlightedwords areefined here.


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What Medicare wont cover

When you choose hospice care, youve decided that you no longer

want care to cure your terminal illness and/or your doctor hasdetermined that efforts to cure your illness arent working. Medicarewont cover any o the ollowing once you choose hospice care:

Treatment intended to cure your terminal illness

alk with your doctor i youre thinking about getting treatment tocure your illness. As a hospice patient, you always have the right tostop hospice care at any time.

Prescription drugs to cure your illness (rather than for symptom

control or pain relief)

Care from any hospice provider that wasnt set up by the hospicemedical team

You must get hospice care rom the hospice provider you chose.All care that you get or your terminal illness must be given by orarranged by the hospice team. You cant get the same type o hospicecare rom a different provider, unless you change your hospiceprovider. However, you can still see your regular doctor i youve

chosen him or her to be the attending medical proessional whohelps supervise your hospice care.

Room and board

Medicare doesnt cover room and board i you get hospice care inyour home or i you live in a nursing home or a hospice inpatientacility. However, i the hospice team determines that you needshort-term inpatient or respite careservices that they arrange,Medicare will cover your stay in the acility. You may have to pay a

small copaymentor the respite stay.

Care in an emergency room, inpatient facility care, or ambulancetransportation, unless its either arranged by your hospice team

or is unrelated to your terminal illness

Note:Contact your hospice team beforeyou get any o these servicesor you might have to pay the entire cost.


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What you pay for hospice care

Medicare pays the hospice provider or your hospice care. Tere is no

deductible. You will have to pay the ollowing: No more than $5 for each prescription drug and other similar

products for pain relief and symptom control.

5% of the Medicare-approved amount for inpatient respite care.

For example, i Medicare pays $100 per day or inpatient respite care,you will pay $5 per day. Te amount you pay or respite care canchange each year.

Hospice care if youre in a Medicare Advantage Plan or other

Medicare health plan

All Medicare-covered services you get while in hospice care arecovered under Original Medicare, even i youre in a MedicareAdvantage Plan (like an HMO or PPO) or other Medicare health plan.Tat includes any Medicare-covered services or conditions unrelatedto your terminal illness or provided by your attending doctor. AMedicare Advantage Plan is a type o Medicare health plan offered by

a private company that contracts with Medicare to provide you with allyour Medicare Part A and Part B benefits. However, i your plan coversextra services not covered by Original Medicare (like dental and visionbenefits), your plan will continue to cover these extra services.


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Care for a condition other than your terminal illness

You should continue to use Original Medicareto get care or any health

care needs that arent related to your terminal illness. You may be ableto get this care rom the hospice team doctor or your own doctor. Tehospice team determines whether any other medical care you need is orisnt related to your terminal illness so it wont affect your care under thehospice benefit.

You must pay the deductibleand coinsuranceamounts or allMedicare-covered services. You must also continue to pay Medicarepremiums, i necessary.

For more inormation about Original Medicare, Medicare AdvantagePlans, and other Medicare health plans, look in your copy o theMedicare & You handbook, which is mailed to every Medicarehousehold in the all. I you dont have the Medicare & You handbook,you can view or print it by visiting www.medicare.gov/publications.

Information about Medicare Supplement Insurance (Medigap)

policies

I you have Original Medicare, you might have a Medigap policy. YourMedigap policy covers your hospice costs or drugs and respite care,and still helps cover health care costs or problems that arent related toyour terminal illness. Call your Medigap insurance company or moreinormation.

o get more inormation about Medigap policies, visit www.medicare.gov/publicationsto view or print the booklet Choosing a MedigapPolicy: A Guide to Health Insurance or People with Medicare. You can

also call 1-800-MEDICARE (1-800-633-4227). Y users should call1-877-486-2048.
http://www.medicare.gov/publicationshttp://www.medicare.gov/publicationshttp://www.medicare.gov/publicationshttp://www.medicare.gov/publicationshttp://www.medicare.gov/publicationshttp://www.medicare.gov/publications


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How long you can get hospice care

Hospice care is intended or people with 6 months or less to live i the

disease runs its normal course. I you live longer than 6 months, youcan still get hospice care, as long as the hospice medical director orother hospice doctor recertifies that youre terminally ill.

Important: Hospice care is given in benefit periods. You can gethospice care or two 90-day periods ollowed by an unlimited numbero 60-day periods. At the start o each period, the hospice medicaldirector or other hospice doctor must recertiy that youre terminallyill, so you can continue to get hospice care. A benefit period starts the

day you begin to get hospice care and it ends when your 90-day or60-day period ends.

Stopping hospice care

I your health improves or your illness goes into remission, you nolonger need hospice care. Also, you always have the right to stophospice care at any time or any reason. I you stop your hospice care,you will get the type o Medicare coverage you had beore you chosea hospice program (such as treatment to cure the terminal illness). Iyoure eligible, you can go back to hospice care at any time.

Example: Mrs. Jones has terminal cancer and got hospice care or two90-day benefit periods. Her cancer went into remission. At the starto her 60-day period, Mrs. Jones and her doctor decided that, due toher remission, she wouldnt need to return to hospice care at that time.Mrs. Jones doctor told her that i she becomes eligible or hospiceservices in the uture, she may be recertified and can return to hospicecare.


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Your Medicare rights

As a person with Medicare, you have certain guaranteed rights. I

your hospice program or doctor believes that youre no longer eligibleor hospice care because your condition has improved and you dontagree, you have the right to ask or a review o your case. Your hospiceshould give you a notice that explains your right to an expedited (ast)review by an independent reviewer hired by Medicare, called a QualityImprovement Organization (QIO). I you dont get this notice, ask orone.

Note: I you pay out-o-pocket or an item or service your doctor

ordered, but the hospice reuses to give you, you can file a claim withMedicare. I your claim is denied, you can file an appeal.

For more inormation about your Medicare rights, visit www.medicare.gov/publicationsto view or print the booklet Medicare Appeals. Youcan also call 1-800-MEDICARE (1-800-633-4227). Y users shouldcall 1-877-486-2048.

I you have a complaint about the hospice that is providing yourcare, contact your State Survey Agency. Visit www.medicare.gov/ombudsman/resources.aspand select Filing a Complaint orGrievance to find the number o your State Survey Agency. You canalso call 1-800-MEDICARE.

Changing your hospice provider

You have the right to change providers only once during each benefitperiod. You can get hospice care or two 90-day periods ollowed by anunlimited number o 60-day periods.

Finding a hospice program

o find a hospice program, talk to your doctor, or call your statehospice organization. Te hospice program you choose must beMedicare-approved to get Medicare payment. o find out i a certainhospice program is Medicare-approved, ask your doctor, the hospiceprogram, your state hospice organization, or your state healthdepartment.
http://www.medicare.gov/publicationshttp://www.medicare.gov/publicationshttp://www.medicare.gov/ombudsman/resources.asphttp://www.medicare.gov/ombudsman/resources.asphttp://www.medicare.gov/ombudsman/resources.asphttp://www.medicare.gov/ombudsman/resources.asphttp://www.medicare.gov/publicationshttp://www.medicare.gov/publications


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For more information1. Call National Hospice Associations, or visit theirwebsites.

National Hospice & Palliative Care Organization

(NHPCO)1731 King StreetSuite 100Alexandria, Virginia 22314

1-800-658-8898www.nhpco.org

Hospice Association of America228 7th Street, SEWashington, DC 200031-202-546-4759

www.nahc.org/haa

2. Visit www.medicare.gov.

3. Call 1-800-MEDICARE (1-800-633-4227). Y usersshould call 1-877-486-2048.

Note:At the time o printing, these phone numbersand websites were correct. Tis inormation sometimeschanges. o get the most updated phone numbers andwebsites, visit www.medicare.gov/contacts, or call

1-800-MEDICARE.
http://www.nhpco.org/http://www.nahc.org/haahttp://www.medicare.gov/http://www.medicare.gov/contactshttp://www.medicare.gov/contactshttp://www.medicare.gov/http://www.nahc.org/haahttp://www.nhpco.org/


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Definitions

CoinsuranceAn amount you may be required to pay as your share o the costor services afer you pay any deductibles. Coinsurance is usually a percentage

(or example, 20%).CopaymentAn amount you may be required to pay as your share o the costor a medical service or supply, like a doctors visit, hospital outpatient visit, orprescription. A copayment is usually a set amount, rather than a percentage. Forexample, you might pay $10 or $20 or a doctors visit or prescription.

DeductibleTe amount you must pay or health care or prescriptions, beoreOriginal Medicare, your prescription drug plan, or your other insurance beginsto pay.

Medicare-approved amountIn Original Medicare, this is the amount adoctor or supplier that accepts assignment can be paid. It may be less than theactual amount a doctor or supplier charges. Medicare pays part o this amountand youre responsible or the difference.

Medicare health planA plan offered by a private company that contractswith Medicare to provide Part A and Part B benefits to people with Medicarewho enroll in the plan. Medicare health plans include all Medicare Advantage

Plans, Medicare Cost Plans, Programs o All-inclusive Care or the Elderly(PACE) and in some cases, plans available under Demonstration/PilotPrograms.

Medigap policyMedicare Supplement Insurance sold by private insurancecompanies to fill gaps in Original Medicare coverage.

Original MedicareOriginal Medicare is ee-or-service coverage under whichthe government pays your health care providers directly or your Part A and/orPart B benefits.

Quality Improvement Organization (QIO)A group o practicing doctorsand other health care experts paid by the ederal government to check andimprove the care given to people with Medicare.

Respite careemporary care provided in a nursing home, hospice inpatientacility, or hospital so that a amily member or riend who is the patientscaregiver can rest or take some time off.


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State Hospice Organizations

Alabama

Alabama Hospice Organization

1-800-355-1973AlaskaHospice and Home Care o Juneau, Alaska1-907-463-6111

Hospice o Mat-Su, Alaska1-907-352-4800

American Samoa

Hospice Organization o American Samoa

1-684-633-1187

Arizona

Arizona Hospice and Palliative CareOrganization1-480-491-0540

ArkansasArkansas Hospice Inc.1-877-257-3400

California

Hospice and Palliative Care Association oCaliornia and Nevada1-888-252-1010

Colorado

Hospice Organization o Colorado1-303-694-4728

ConnecticutHospice and Palliative Care Council oConnecticut1-203-265-9931

Delaware

Delaware Hospice1-800-838-9800

Florida

Hospices and Palliative Care Inc. o Florida

1-800-282-6560GeorgiaHospice Organization o Georgia1-877-924-6073

GuamHospice Organization o Guam1-671-457-5355

Hawaii

Hospice Organization o the HawaiianIslands1-800-474-2113

IdahoHospice Organization o Idaho1-208-841-1862

IllinoisIllinois Hospice and Palliative Care Org.

1-888-844-7706

Indiana

Hospice and Palliative Care Organization oIndiana1-866-254-1910

Iowa

Iowa Hospice Organization1-800-240-1046

KansasKansas Hospice and Palliative CareOrganization1-316-207-1764


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Kentucky

Hospice and Palliative Care Association o

Kentucky1-888-322-7317

LouisianaLouisiana and Mississippi HospiceOrganization1-888-546-1500

Maine

Maine Hospice Council

1-800-438-5963MarylandHospice Network o Maryland1-410-729-4571

MassachusettsHospice and Palliative Care Federation oMassachusetts1-800-962-2973

MichiganHospice and Palliative Care Organization oMichigan1-800-536-6300

MinnesotaHospice Minnesota1-800-214-9597

Mississippi

Louisiana and Mississippi HospiceOrganization1-888-546-1500

MissouriHospice and Palliative Care Association oMissouri1-573-634-5514

Montana

M.H.A. - An Association o Montana Health

Care Providers1-800-351-3551

NebraskaHospice and Palliative Care Association oNebraska1-402-477-0204

Nevada

Hospice and Palliative Care Association o

Caliornia and Nevada1-888-252-1010

New HampshireNew Hampshire Hospice and Palliative CareOrganization1-603-225-0900

New Jersey

Hospice and Palliative Care Organization oNew Jersey1-908-233-0060

New Mexicoexas and New Mexico Hospice Organization1-800-580-9270

New York

Hospice and Palliative Care Association oNew York State1-800-860-9808

North Carolina

Carolinas Center or Hospice & End-o-LieCare1-800-662-8859

North Dakota

Hospice Organization o Red River Valley1-800-237-4629


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Northern Mariana Islands

Hospice Organization o Northern MarianaIslands1-670-234-8950

OhioHospice and Palliative Care Organization oOhio1-800-776-9513

Oklahoma

Hospice Association o Oklahoma1-405-513-8602

OregonHospice Association o Oregon1-888-229-2104

PennsylvaniaPennsylvania Hospice Network1-866-554-6774

Puerto Rico

Home Health and Hospice Association o

Puerto Rico1-800-981-2364

Rhode Island

Home and Hospice Care o Rhode Island1-800-338-6555

South CarolinaCarolinas Center or Hospice & End-o-LieCare

1-800-662-8859South Dakota

Avera Queen o Peace/Mitchell CommunityHospice o South Dakota1-605-945-0827

TennesseeAlive Hospice1-800-258-9541

Texas

exas and New Mexico Hospice Organization1-800-580-9270

UtahUtah Hospice and Palliative Care1-801-582-2245

VermontHospice and Palliative Care Council oVermont1-802-229-0579

Virgin Islands

Hospice Organization o Virgin Islands1-340-772-2273

Virginia

Virginia Association or Hospices1-804-740-1344

WashingtonWashington State Hospice and Palliative CareOrganization

1-866-661-3739

Washington, DC

Hospice Network o Maryland1-410-729-4571

West Virginia

Hospice Care o Huntington1-800-788-5480

WisconsinTe HOPE o Wisconsin1-800-210-0220

WyomingHospice Organization o Wyoming1-307-721-8885


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U.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services7500 Security BoulevardBaltimore, Maryland 21244-1850

Official BusinessPenalty for Private Use, $300

CMS Product No. 02154Revised August 2012

Tis booklet is available in Spanish. o get a freecopy, call 1-800-MEDICARE (1-800-633-4227).Y users should call 1-877-486-2048.

Necesita usted una copia en espaol?Para obtener su copia GRAIS, llame al1-800-MEDICARE (1-800-633-4227).

medicare hospice benefits 2012

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