If you qualify for the hospice benefit, Medicare covers the following:
- Skilled nursing services, which are services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness. Services you may receive include injections (and teaching you to self-inject), tube feedings, catheter changes, observation and assessment of your condition, management and evaluation of your care plan, and wound care.
- Skilled therapy services, which are physical, speech, and occupational therapy services that are reasonable and necessary to manage your symptoms or help maintain your ability to function and carry out activities of daily living (eating, dressing, toileting). Performed by or under the supervision of a licensed therapist.
- Hospice aides and homemaker services, including full coverage of a hospice aide to provide personal care services, including help with bathing, toileting, and dressing, as well as some homemaker services (changing the bed, light cleaning and laundry).
- Medical supplies, including full coverage of certain medical supplies, such as wound dressings and catheters.
- Durable medical equipment (DME), including full coverage of equipment needed to relieve pain or manage your terminal medical condition.
- Respite care, which means short-term inpatient An inpatient is a patient who has been formally admitted into the hospital by a doctor. Most inpatient care is covered under Medicare Part A (hospital insurance). stays for you that allow your caregiver to rest. This coverage includes up to five consecutive inpatient days at a time. You will pay a copayment of no more than 5% of the Medicare-approved amount for each day. Your total copays for respite care should be no more than the inpatient hospital deductible amount for the year you first elected hospice care.
- Short-term inpatient care, which is care at a hospital, SNF, or hospice inpatient facility if your medical condition calls for a short-term stay for pain control or acute or chronic symptom management. Only covered if care cannot feasibly be provided in another setting.
- Medical social services, including full coverage of services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This may include counseling and/or help finding resources in your community.
- Prescription drugs related to pain relief and symptom control. You pay a $5 copay.
- Spiritual or religious counseling
- Nutrition and dietary counseling
While you are receiving care under the Medicare hospice benefit, you can still get Medicare coverage for treatment of illnesses and injuries unrelated to your terminal condition. Coverage for such care would be provided however you received benefits prior to hospice, either through Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. or Medicare Advantage, and you should expect to pay normal cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. amounts.
For hospice billing questions, call 1-800-MEDICARE and ask for contact information for the Medicare Administrative Contractor (MAC) Medicare Administrative Contractors (MACs) are private companies that process Part A and Part B medical claims or Durable Medical Equipment (DME) claims for Original Medicare beneficiaries. Each MAC serves a defined geographic area. To find the MAC in your region, call 1-800-MEDICARE. in your region. For general questions and counseling, contact your State Health Insurance Assistance Program (SHIP).