***Understanding the Medicare Hospice Benefit

Today, I want to talk to you about the Medicare Hospice benefit. Now, I know that many of you reading this aren’t quite of Medicare age, but most insurances follow Medicare’s guidelines, so they are applicable in most cases.

Requirement number one; a physician, in his or her clinical judgment, must certify that an individual’s illness, if it takes its expected course, will cause the individual’s death in 6 month or less. This does not mean one gets cut off from their benefit after 6 months. As long as a person continues to meet the eligibility criteria, they can continue to receive hospice service.

Once a person begins receiving services, they will be seen by the hospice team on a regular basis. That team includes physicians (both the patient’s physician and the hospice physician), nurses, social workers, home health aides, chaplains, and volunteers. The frequency with which an individual sees these team members is determined by the patient and family needs.

Medications, supplies and medical equipment related to the terminal illness are paid for by the hospice benefit. The hospice nurse will inform you what medications are being paid for and what aren’t.

The hospice benefit is broken down into “certification periods”. These are increments in which the hospice team needs to formerly re-evaluate a patient’s appropriateness for hospice care. The first two benefit periods are 90 days each. Subsequent periods are 60 days apart. As a new certification period approaches, your hospice team will assess the patient and determine whether they continue to meet hospice criteria or not.

There are four levels of hospice care. They are Routine, Inpatient, Continuous Care and Respite. I will describe these in more detail in my next article so stay tuned. As a sneak peak, 2 of these levels can be done in any living setting and two must be done in a skilled living environment such as a nursing home, hospice inpatient unit, or a hospital.

So now you have a basic understanding of the hospice benefit. For more information, you can contact me at: swarsaw@boomer-living.com.

Tags: certification period, continuous care, eligibility criteria, medicare hospice benefit, terminal illness