Hospice services are for when you are terminally ill and the prognosis is six months or less. You can receive hospice care at home if you decide not to seek further medical treatment aimed at curing the illness.
How do hospice services work?
When you sign up for hospice, it is usually 100% covered by Medicare, Medicaid or private insurance. The hospice provider will receive a set dollar amount for every day you’re their patient. The hospice care provider pays for all of your comfort care out of its daily rate.
While you’re receiving hospice services, you’re only supposed to get healthcare services related to your terminal illness from that hospice provider or from a medical provider it contracts with. If your condition requires oxygen and a hospital bed, you can get these expenses covered by using the medical equipment company your hospice provider contracts with.
You continue to have the right to seek any kind of treatment you wish for anything not related to the hospice diagnosis. For example, if you receive hospice services for terminal cancer, you may continue to see your cardiologist for treatment of your heart disease, because it has nothing to do with your hospice illness. Hospice won’t pay for the cardiologist out of its daily rate since the cardiologist isn’t treating the terminal illness. However, Medicare, Medicaid, or private insurance will continue to pay for that, since it is not related to the hospice coverage.
Can I Change My Mind?
You absolutely can change your mind about receiving hospice services at any time. You may revoke the hospice benefit and return to regular Medicaid/Medicare/Private Insurance coverage. You also may transfer to a different hospice provider, if you are not satisfied with the current hospice’s care.
What Do Hospice Services Include?
All of the care related to your terminal illness, including medications and equipment necessary to keep you comfortable at home, are included in hospice services. It will provide:
- Hospice doctors and nurses to oversee your care
- Medications necessary to control your symptoms
- Home health aides to help with bathing and personal care
- Medical equipment like a wheelchair or hospital bed necessary to keep you comfortable
- Social workers to help you with advance care planning, caregiver stress, and dealing with grief
- Respite to relieve the family from caregiving for up to five days
- Specialized therapy needed to keep you comfortable or teach you how to cope with changes in your abilities as the disease progresses
- Inpatient care at a hospital or hospice facility to closely monitor and address uncontrolled symptoms
- Anything else the hospice team approves to keep you comfortable and improving your quality of life
What is Hospice Services Not Going to Cover?
Hospice services do not cover any medical treatment provided with the intent of curing your terminal illness. For example, it might cover the cost of radiation therapy provided to shrink a tumor that is causing pain because it is pressing against a nerve. It wouldn’t cover radiation therapy provided to eliminate the tumor.
The key difference is the intent of the treatment. If it is provided to control your symptoms and ensure you are comfortable, it is included in hospice services. If the treatment is an attempt to cure your terminal illness, it’s not appropriate for hospice.
Emergency room and ambulance services are usually only covered if your hospice team feels they’re necessary and related to the hospice diagnosis.