CENTERS FOR MEDICARE & MEDICAID SERVICES edicare Holpice Benefits This official government booklet includes information about Medicare hospice benefits: * Who is eligible for hospice care * 'UBS What services are included ?'26 * How to find a hospice program 3 ^654 * Where to get more information 011 Welcome Choosing hospice care is a difficult decision. The information in this booklet and the support given by a doctor and trained hospice care team can help you choose the most appropriate health care options for someone who is terminally ill. Whenever possible, include the person who w may need hospice care in all health care decisions. "Medicare Hospice Benefits" isn't a legal document. Official Medicare Program legalguidance is contained in the relevant statutes, regulations, and rulings. The information in this booklet was correct when it was printed. Changes may occur after printing. Visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get the most current information. TTY users should call 1-877-486-2048. Table of Contents Hospice Care 4 Medicare Hospice Benefits 4 How HospiceWorks 5 WhatMedicare Covers 6 Respite Care 6 What MedicareWon'tCover 7 WhatYou PayforHospice Care 8 Hospice Care ifYou're in a MedicareAdvantage Plan orOtherMedicare Health Plan 8 Carefora Condition OtherthanYourTerminal Illness .9 Information about Medicare Supplement Insurance (Medigap) Policies 9 How LongYou Can Get Hospice Care 10 Stopping Hospice Care 10 Your Medicare Rights 11 ChangingYour Hospice Provider 11 Finding a Hospice Program 11 ForMore Information 12 Definitions 13 14-15 State Hospice Organizations 4 Hospice Care Hospice is a program ofcare and support for people who are terminally ill. Here are some important facts about hospice: Hospice helps people who are terminally ill live comfortably. The focus is on comfort, not on curing an illness. A specially trained team ofprofessionals and caregivers provide care for the "whole person," including his or her physical, emotional, social, and spiritual needs. Services may include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related condition(s). Care is generally provided in the home. Hospice isn't only for people with cancer. Family caregivers can get support. Medicare Hospice Benefits You can get Medicare hospice benefits when you meet all ofthe following conditions: A You're eligible for Medicare Part (Hospital Insurance). Your doctor and the hospice medical director certify that you're terminally ill and have 6 months or less to live ifyour illness runs its normal course. You sign a statement choosing hospice care instead ofother Medicare-covered benefits to treat your terminal illness. (Medicare will still pay for covered benefits for any health problems that aren't related to your terminal illness.) You get care from a Medicare-approved hospice program. 5 How Hospice Works Your doctor and the hospice team will work with you and your family to set up a plan ofcare that meets your needs. Your plan ofcare includes hospice services that Medicare covers. For more specific information on a hospice plan ofcare, call your state or national hospice organization (see pages 12 and 14-15). Ifyou qualify for hospice care, you will have a specially trained team and support staffavailable to help you and your family cope with your illness. You and your family members are the most important part ofthe team. Your team may also include some or all ofthe following 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 family support and care when you need it. A hospice doctor is part ofyour medical team. Your regular doctor or a nurse practitioner can also be part ofthis team as the attending medical professional to supervise your care. However, only your regular doctor (not a nurse practitioner that you've chosen to serve as your attending medical professional) and the hospice medical director can certify that you're terminally ill and have 6 months or less to live. The hospice benefit allows you and your family to stay together in the comfort ofyour home unless you need care in an inpatient facility. If the hospice team determines that you need inpatient care, the hospice team will make the arrangements for your stay. 6 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 symptoms management. You don't need to choose hospice care to take advantage ofthis consultation service. Medicare will cover the hospice care you get for your terminal illness, but the care you get must be from a Medicare-approved hospice program. Important: Medicare will still pay for covered benefits for any health problems that aren't related to your terminal illness, such as care for an injury. Medicare covers the following hospice services when they're needed to care for 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 for symptom control or pain relief(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 Griefand loss counseling for you and your family Short-term inpatient care (for 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 byyour hospice team Respite Care You can get inpatient respite care in a Medicare-approved facility (such as a Words in blue hospice inpatient facility, hospital, or nursing home) ifyour usual caregiver are defined on (such as a family member) needs a rest. You can stay up to 5 days each time page 13. you get respite care. You can get respite care more than once, but it can only be provided on an occasional basis. 7 What Medicare Won't Cover When you choose hospice care, you've decided that you no longer want care to cure your terminal illness and/or your doctor has determined that efforts to cure your illness aren't working. Medicare won't cover any ofthe following once you choose hospice care: Treatment intended to cure your terminal illness Talk with your doctor ifyou're thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop 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 wasn't set up by the hospice medical team You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type ofhospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor ifyou've chosen him or her to be the attending medical professional who helps supervise your hospice care. Room and board Medicare doesn't cover room and board ifyou get hospice care in your home or ifyou live in a nursing home or a hospice inpatient facility. However, ifthe hospice team determines that you need short-term inpatient or respite care services that they arrange. Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay. Care in an emergency room, inpatient facility care, or ambulance transportation, unless it's either arranged byyour hospice team or is unrelated to your terminal illness Note: Contact your hospice team before you get any ofthese services or you might have to pay the entire cost. WhatYou Pay for Hospice Care Medicare pays the hospice provider for your hospice care. There is no deductible. You will have to pay the following: No more than $5 for each prescription drug and other similar products for pain reliefand symptom control. 5% ofthe Medicare-approved amount for inpatient respite care. For example, ifMedicare pays $100 per day for inpatient respite care, you will pay $5 per day. The amount you pay for respite care can change each year. Hospice Care ifYou're in a Medicare Advantage Plan or Other Medicare Health Plan All Medicare-covered services you get while in hospice care are covered under Original Medicare, even ifyou're in a Medicare HMO Advantage Plan (like an or PPO) or other Medicare health plan. That includes any Medicare-covered services for conditions unrelated to your terminal illness or provided by your attending doctor. A Medicare Advantage Plan is a type ofMedicare health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. However, ifyour plan covers extra services not covered by Original Medicare (like dental and vision benefits), your plan will continue to cover these extra services. 9 Care for a Condition Other than Your Terminal Illness You should continue to use Original Medicare to get care for any health care needs that aren't related to your terminal illness. You may be able to get this care from the hospice team doctor or your own doctor. The hospice team determines whether any other medical care you need is or isn't related to your terminal illness so it won't affect your care under the hospice benefit. You must pay the deductible and coinsurance amounts for all Medicare-covered services. You must also continue to pay Medicare premiums, ifnecessary. For more information about Original Medicare, Medicare Advantage Plans, and other Medicare health plans, look in your copy ofthe & "Medicare You" handbook, which is mailed to every Medicare & household in the fall. Ifyou don't have the "Medicare You" handbook, you can view or print it byvisiting www.medicare.gov/publications. Information about Medicare Supplement Insurance (Medigap) Policies Ifyou have Original Medicare, you might have a Medigap policy. Your Medigap policy covers your hospice costs for drugs and respite care, and still helps cover health care costs for problems that aren't related to your terminal illness. Call your Medigap insurance company for more information. To get more information about Medigap policies, visit www.medicare.gov/publications to view or print the booklet "Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare." You can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Wordsin blue aredefined on page 13. How Long You Can Get Hospice Care Hospice care is intended for people with 6 months or less to live ifthe disease runs its normal course. Ifyou live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you're terminally ill. Important: Hospice care is given in benefit periods. You can get hospice care for two 90-day periods followed by an unlimited number of60-day periods. At the start ofeach period, the hospice medical director or other hospice doctor must recertify that you're terminally A ill, so you can continue to get hospice care. benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60-day period ends. Stopping Hospice Care Ifyour health improves or your illness goes into remission, you no longer need hospice care. Also, you always have the right to stop hospice care at any time for any reason. Ifyou stop your hospice care, you will get the type ofMedicare coverage you had before you chose a hospice program (such as treatment to cure the terminal illness). Ifyou're eligible, you can go back to hospice care at any time. Example: Mrs. Jones has terminal cancer and got hospice care for two 90-day benefit periods. Her cancer went into remission. At the start ofher 60-day period, Mrs. Jones and her doctor decided that, due to her remission, she wouldn't need to return to hospice care at that time. Mrs. Jones' doctor told her that ifshe becomes eligible for hospice services in the future, she may be recertified and can return to hospice care.