One of the benefits of original Medicare Part A is hospice care. Hospice care takes place after all reasonable attempts to cure a fatal condition have failed or the patient prefers to end aggressive treatment. Medicare has specific guidelines regarding when it will pay for hospice services. For a patient to claim Medicare hospice coverage, a doctor must certify that the patient is in the last six months of a terminal illness. The patient must also state, in writing, that he chooses hospice care and does not want to continue with curative treatment.
Services Covered at 100 Percent
Medicare covers many hospice services at 100 percent. As long as she is enrolled in Part A, a terminally ill patient does not have to pay any costs for nutrition or spiritual counseling; medically-related social services; visits from home health aides, nurses, doctors and hospice volunteers; skilled therapy or bereavement support for the family. The patient does have to get all hospice services from a provider approved by Medicare, however.
Respite Care
Medicare will pay 95 percent of the costs for inpatient respite care. A hospice patient can stay for up to five days at a time in an approved nursing home or hospital to provide a break for the family or caregivers and only have a co-payment of 5 percent, as of 2011. There is no limit on the amount of times a patient can take respite care days.
Prescriptions
As of 2011, hospice patients pay no more than $5 for each prescription they need for symptom control and for pain relief. This applies even if you have a Medicare Advantage plan rather than original Medicare, because hospice benefits are always taken care of by original Medicare.
Health Problems Other Than a Terminal Condition
During the course of hospice care, a patient may need to use Medicare for help with other health problems unrelated to the terminal condition. In these cases, regular Medicare costs apply, even if they are provided by the doctor or nurses from the hospice care team. If a deductible amount, coinsurance or copay applies to the service, the patient will be responsible for them under normal Medicare rules.
Services for Which Medicare Won't Pay
Medicare will not cover room and board costs while a patient is using hospice benefits, even if a patient lives in a nursing or residential home. Other services Medicare does not pay for hospice patients are emergency room services, unless they are not related to the terminal illness, and treatment or prescription drugs meant to cure the illness. Medicare will also not pay for services rendered by a hospice agency different than the patient has already chosen. Patients can always decide to change hospice providers, however.
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