Medicare & Insurance Services
To be eligible for Medicare coverage for hospice care, a client’s physician must certify that he or she is terminally ill and has a life expectancy of six months or less. Clients receiving hospice care will no longer receive treatment toward a cure, but they still require and will receive the close medical and supportive care that hospice provides. Hospice care under Medicare includes both home care and inpatient care, when needed, and a variety of services not otherwise covered by Medicare.
Medicare coverage for hospice care is available under the following conditions:
- The client is eligible for Medicare Part A hospital insurance.
- The client’s doctor and the hospice medical director certify that the client is terminally ill, with six months or less to live if the disease runs its normal course.
- The client signs a statement choosing hospice care instead of standard Medicare benefits for the terminal illness.
- The client receives care from a Medicare-approved hospice program.
How Long Can Hospice Care Continue?
Although hospice care is intended for the final six months of life, hospice care is not discontinued if a client lives beyond that time. Hospice of Jefferson County is responsible for determining at regular intervals whether the client meets the hospice criteria, and it will plan with the client and family if the situation improves and hospice is no longer required.
Coverage Under Medicare
Under Medicare, hospice is primarily a program of care delivered in a person’s home by a Medicare-certified hospice. Hospice care is covered under Medicare Part A. When using the Medicare hospice benefit, standard Medicare benefits are waived only for treatment of the terminal illness. For all other health care problems, coverage is continued under Medicare Part A and Part B. The Medicare hospice benefit pays for the following services:
- Physician services
- Nursing services (intermittent, with 24-hour on-call service)
- Social worker services
- Home health aide services
- Spiritual counseling
- Bereavement counseling
- Prescriptions for pain control and symptom relief
- Medical equipment such as beds, wheelchairs, and walkers
- Medical supplies such as bandages, catheters, etc.
- Short-term care in the hospital, if needed
- Dietary counseling
- Physical, occupational, and speech therapy
Medicaid/Department of Social and Health Services
Washington State has implemented a hospice benefit under the Department of Social and Health Services. As with the Medicare program, clients with DSHS must have a physician certify that he or she has a terminal illness and must sign appropriate consent forms electing to receive hospice care in place of the standard Medicaid benefits.
Each person’s insurance policy differs. Most insurance policies, including HMOs and PPOs, include some coverage for hospice care. Hospice of Jefferson County will assist clients in determining the extent of their insurance coverage.
If the person seeking hospice care has limited insurance coverage or no coverage for hospice services, Hospice of Jefferson County will work with the client and his or her family to determine the client’s eligibility for financial aid or to set up a reasonable payment schedule. Our desire is to offer services to clients in need, and we will work with clients and their families to make that happen.
Contact Hospice of Jefferson County at 360-385-0610.