Medicare covers hospice care for two initial 90-day benefit periods, or a total of six months. After this, it will cover an unlimited amount of 60-day (two-month) benefit periods. At the start of each benefit period The benefit period is the amount of time during which Medicare pays for hospital and skilled nursing facility (SNF) services. A benefit period begins the day you are admitted to a hospital as an inpatient, or to a SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. With each new benefit period, you pay a new deductible. Your coinsurance is determined by the number of days you have been in the facility during each benefit period. , your hospice doctor or a related provider must recertify that you have a life expectancy of six months or less.
If you continue hospice past your two initial benefit periods, you are required to have a face-to-face meeting with a hospice doctor or nurse practitioner before the start of each additional 60-day benefit period. Meetings should take place before the end of your current benefit period but no earlier than 30 days before the new benefit period.
You have the right to ask for a review of your case if a hospice provider has declared you no longer eligible for hospice care. This provider is required to give you a notice explaining your right to an expedited appeal An expedited appeal is a fast appeal of an Original Medicare, Medicare Advantage, or Medicare Part D plan’s denial of coverage when a person’s “life, health, or ability to regain maximum function” is in jeopardy. . If you do not get this notice, ask for it. Instructions for appealing should be provided on the notice.
You also have the right to change your hospice provider once per benefit period. To change your hospice provider, you must sign a statement naming the new hospice provider you plan to receive care from, your previous hospice provider, and the effective date of the change. This statement must be filed at both hospice agencies.