Your doctor and the hospice team will work with you and your family to set up a plan of care that meets your needs. Your plan of care includes hospice services that Medicare covers. For more specific information on a hospice plan of care, call your national or state hospice organization.
If you qualify for hospice care, you'll have a specially trained team and support staff available to help you and your family cope with your illness.
You and your family members are the most important part of a team that may also include:
- Nurses or nurse practitioners
- Social workers
- Physical and occupational therapists
- Speech-language pathologists
- Hospice aides
- Trained 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 of your medical team. Your regular doctor or a nurse practitioner can also be part of this 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 of your 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.
Where you get hospice care
Most hospice patients get hospice care in the comfort of their home and with their families. Depending on your condition, you may also get hospice care in a Medicare-approved hospice facility, hospital, nursing home, or other long-term care facility.
How long you can get hospice care
Hospice care is intended for people with 6 months or less to live if the disease runs its normal course. If you 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. Hospice care is given in benefit periods. A benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60-day period ends.
- You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods
- You have the right to change providers only once during each benefit period
- At the start of each period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill, so you can continue to get hospice care
Finding a hospice program
Consider these questions when selecting hospice care providers:
- Is the hospice program certified and licensed by the state or federal government?
- Does the hospice provider train caregivers to care for you at home?
- How will your doctor work with the doctor in the hospice program?
- How many other patients are assigned to each member of the hospice care staff?
- Will the hospice staff meet regularly with you and your family to discuss care?
- How does the hospice staff respond to after-hour emergencies?
- What measures are in place to ensure hospice care quality?
- What services do hospice volunteers offer? Are they trained?
The hospice program you choose must be Medicare-approved to get Medicare payment. To find out if a certain hospice program is Medicare-approved, ask your doctor, the hospice program, your state hospice organization, or your state health department.
If you'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 if you're in a Medicare Advantage Plan (like an HMO 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.
Care for your other conditions
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, if necessary.
Stopping hospice care
- If your health improves or your illness goes into remission, you no longer need hospice care
- You always have the right to stop hospice care at any time for any reason
- If you stop your hospice care, you'll get the type of Medicare coverage you had before you chose a hospice program (like treatment to cure the terminal illness)
- If you're eligible, you can go back to hospice care at any time