Does Medicare Pay for Hospice?

Hospice care is a special kind of care that provides comfort, support, and dignity at the end of life, typically when you or your loved one’s life expectancy is six months or less. This care addresses your physical, emotional, social, and spiritual needs, and enables you to spend time focusing on what matters most to you.

Fortunately, Medicare does pay for hospice in Southern New Jersey. The Medicare hospice benefit is available to individuals who meet specific criteria.

Who is Eligible for the Medicare Hospice Benefit?

A South Jersey patient must meet the following criteria to qualify for Medicare-covered hospice care:

Medicare Part A or C Enrollment: The patient must be enrolled in Medicare Part A (Hospital Insurance) or Medicare Part C (Medicare Advantage Plans).
Doctor’s Certification: Your regular doctor and the hospice medical director must certify that you have a life expectancy of six months or less if the illness runs its normal course.
Choice of Care: You must choose to receive hospice care instead of curative treatment for your terminal illness, opting for care focused on comfort and quality of life.
Medicare-Approved Hospice Program: The hospice care must be provided by a Medicare-approved hospice program.

What Does the Medicare Hospice Benefit Cover?

The Medicare Hospice Benefit covers a wide range of services aimed at providing comfort and support to terminally ill patients and their families. You may be responsible for a small copayment. These services include:

Doctor Services: Medical care provided by a physician.
Nursing Care: Skilled nursing care to manage pain and other symptoms.
Medical Equipment: Necessary medical equipment such as wheelchairs, hospital beds, and walkers.
Medical Supplies: Consumable medical supplies like bandages, catheters, and gloves.
Prescription Drugs: Medications for symptom control and pain relief.
Hospice Aide and Homemaker Services: Assistance with personal care, such as bathing and dressing, as well as help with household chores.
Physical, Occupational, and Speech Therapy: Therapeutic services to help the patient maintain as much independence and comfort as possible.
Social Work Services: Support from social workers to help with emotional and social needs.
Dietary Counseling: Nutritional guidance to ensure the patient’s dietary needs are met.
Grief Counseling: Grief and loss counseling for both the patient and their family.
Short-term Inpatient Care: Short-term care in a hospital or hospice facility for pain and symptom management that cannot be managed at home.
Short-term Respite Care: Short-term inpatient care to provide respite for the patient’s primary caregiver.

What is Not Covered Under the Medicare Hospice Benefit?

Exclusions under the Medicare Hospice Benefit exist to ensure that the focus remains on comfort care rather than curative. The following is not covered by Medicare:

Curative Treatment: Any treatment aimed at curing terminal illness rather than providing comfort care is not covered.
Room and Board: Medicare does not cover room and board costs if you receive hospice care at home or reside in a nursing home or hospice inpatient facility. However, if short-term inpatient or respite care is arranged by the hospice team, Medicare will cover the stay, but you might have to pay a small copayment for the respite care.

Care Not Arranged by the Hospice Team: Any care that is not arranged by the hospice team is not covered. This may include emergency room visits, hospital inpatient care, and ambulance transportation. It may also include care for a condition unrelated to your terminal illness or treatments intended to cure the terminal illness. For example, if a person has long-standing blood pressure but is admitted to hospice due to terminal cancer, the hospice benefit will pay for the cancer drugs but not the blood pressure medications.

How Long Will Medicare Pay for Hospice Care?

Medicare will pay for hospice care as long as the patient meets the eligibility criteria, with the care being provided in benefit periods. These benefit periods are structured as follows:

First Benefit Period: 90 days
Second Benefit Period: 90 days
Subsequent Benefit Periods: Unlimited 60-day periods

For each benefit period to be covered, the patient must be re-certified by the hospice medical director or another hospice doctor as terminally ill with a life expectancy of six months or less. This re-certification process occurs at the beginning of each new benefit period. If the patient continues to meet the criteria and is re-certified appropriately, Medicare will continue to cover hospice care.

What is Inpatient Hospice Care?

In hospice care, sometimes you or your loved one may experience symptoms that are severe and unrelieved. A hospice team will do their best to manage these symptoms in your home environment.

These symptoms include pain, shortness of breath, nausea and vomiting, and severe anxiety. The hospice team will work with you, your family, and your physician to make any necessary changes to you or your loved one’s medications or other treatments to relieve these symptoms.

However, sometimes these symptoms do not respond to the regular medications available in the home environment. When these symptoms do not improve over 24 to 48 hours, then the hospice nurse may decide to transfer you or your loved one to an inpatient center so symptoms can be managed more quickly. Examples of inpatient centers in South Jersey include The Samaritan Centers at Voorhees and Mount Holly.

What are the Medicare Guidelines for Inpatient Hospice?

Medicare provides specific guidelines for inpatient hospice care to ensure patients receive appropriate and necessary services.

Symptom and Pain Management: The patient’s symptoms and pain cannot be effectively managed at home.
Approved Facilities: The inpatient care must be provided in a Medicare-approved facility such as a hospice inpatient unit, hospital, or skilled nursing facility.
Respite Care Costs: For inpatient respite care, you may need to pay 5% of the Medicare-approved amount. However, your copayment will not exceed the inpatient hospital deductible for the year.
Room and Board: Medicare does not cover room and board if you receive hospice care at home or if you live in a South Jersey nursing home or hospice inpatient facility. However, if the hospice team determines you need short-term inpatient or respite care, Medicare will cover the stay. You may need to pay a small copayment for the respite care.

How Do You Pay for Hospice Without Medicare?

There are many other ways for South Jersey residents to pay for hospice without Medicare. This can include Medicaid, private insurance, Veterans Affairs (VA) benefits, out-of-pocket, charitable organizations, or non-profit hospices.

Hospice Care in South Jersey with Samaritan

Samaritan is certified by Medicare to provide hospice care services in Southern New Jersey. We ensure patients receive the comfort and support they need during their end-of-life journey. With a dedicated team of professionals and two inpatient hospice locations in Voorhees and Mount Holly, we focus on enhancing the quality of life for patients and their families.

If you have any questions about Medicare and hospice care, or hospice services in South Jersey, please call us at (856) 596-1600 or complete this online patient referral form.

Have more questions about Medicare and inpatient hospice care in South Jersey?

Please call our Nurse Care Coordinator

(856) 596-1600