 The hospice care benefit is available from a variety of sources. Medicare, Medicaid, managed care programs and, in most cases, private insurance companies provide coverage for hospice care.
Medicare
Most of our patients are eligible for Medicare coverage. Autumn Journey Hospice’s services are fully reimbursable by Medicare at no cost to the patient. Autumn Journey requires no co-payments for our services from our Medicare patients.
Medicare Eligibility
Patients are eligible for Medicare hospice benefits if:
- they are eligible for Medicare Part A (also called the hospital insurance portion of Medicare)
- the patient’s doctor and our Medical Director certify that the patient has a life-limiting illness or condition
- the patient chooses to discontinue treatments aimed at attempting to cure the disease or condition and elects to receive only treatment that eases pain and discomfort
- a Medicare-certified hospice agency, such as Autumn Journey Hospice, provides the care
Under the Medicare hospice benefit, beneficiaries elect to receive palliative care, treatment that helps ease pain and discomforting symptoms, rather than trying to cure an illness or condition. Note that by accepting the hospice benefit of Medicare, the patient waives Medicare coverage for treatment of the life-limiting illness or condition. However, the patient may continue to use Medicare Part A benefits for treatment of illnesses or conditions unrelated to the life-limiting illness.
Medicare hospice benefits include:
- physician services related to the life-limiting illness or condition
- regular home care visits by a registered nurse
- visits by a Certified Nurse Aide for such services as dressing and bathing
- non-denominational chaplain services for the patient and the family, as desired
- social worker and counseling services
- medical equipment such as a hospital bed, wheelchair, shower stool or walker
- medical supplies such as bandages, catheters and adult diapers
- prescription drugs to control symptoms and relieve pain
- dietary counseling
- any therapy that may be necessary
- respite care
- bereavement counseling.
Managed Care/HMO/Private Insurance
We will work with you and your hospice benefit provider to maximize any hospice benefits available. Managed care organizations must allow patients or their families to select the hospice agency of their choice.
However, you should consult with your insurance provider to determine the type and amount of coverage it provides for hospice care.
Private Pay
For those who may elect to do so, we also accept direct payment from the patient for our services.
Other Sources
There are also other non-profit, not for profit and charitable sources that provide hospice care services. Should you require such a resource, we will be happy to provide referrals and assistance to help you in your search for care.
Please note that your Medicare Hospice Benefit does not cover the following types of care:
- Treatment to cure a patient’s life-limiting illness or condition.
The philosophy of hospice is to provide comfort and care, including medication, which helps control symptoms and ease pain. Patients receiving treatments to cure their disease are not eligible for hospice care, except possibly as mentioned in the Private Insurance section above.
- Care from two hospice providers.
Patients must elect to receive service from a single hospice care provider. However, the patient may change providers at any time.
- Room and board in nursing homes, residential assisted living homes, retirement homes or other similar facilities
We are often asked if there are in-patient hospice facilities covered by the Medicare Hospice Benefit. The answer, unfortunately, is no. A number of the national hospice organizations also own nursing homes. However, since Medicare only pays for the care provided under the Hospice Benefit, you can expect to be billed for any services not related to hospice care that these facilities provide, in particular room and board charges.
Under certain conditions, Medicare does provide coverage for nursing home care, if the patient enters the nursing home directly from the hospital. However, this coverage should not be confused with hospice care coverage under the Medicare Hospice Benefit.
- Companion caregivers, aides, attendants, sitters or homemakers
One of the basic philosophies of Medicare Hospice Benefit is that primary hands-on patient care is provided by the patient’s spouse, significant other, partner, family members or other loved ones, as may be appropriate. There is no provision in the Medicare Hospice Benefit to pay for these types of services. Unless you have private insurance that provides coverage for these services, you will be responsible for the costs of such services.
The patient’s physician can continue to treat illnesses or conditions not related to the terminal illness.
When the patient requires treatment for illnesses or conditions not related to his/her hospice care, the patient’s Medicare Part A coverage will still apply, as will most private medical insurance policies. In the case of private insurance coverage, the patient may have to meet deductibles and coinsurance amounts.
For information about Medicare health plans, refer to the Medicare handbook or website at www. Medicare.gov. If you have personal insurance coverage, please refer to your policy.
Autumn Journey Hospice
5347 Spring Valley Road
Dallas, TX 75254
Phone: 972.233.0525
Email: wecare@autumnjourneyhospice.com
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