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Medicare and Insurance

Medicare

Medicare covers all services and supplies for the hospice patient, except in skilled nursing facilities. In a skilled nursing facility the cost of room and board is the responsibility of the patient and/or family, just as the mortgage payment for an individual who receives care in his or her home continues to be a monthly obligation. In some hospices, the patient may be required to pay a 5% or $5 co-payment for medication and respite care. You should find out about any co-payment when considering a hospice. Hospice of Palm Beach County does not charge this co-payment. To be eligible for the Medicare Hospice Benefit, a patient must be entitled to Medicare Part A benefits and must be certified as terminally ill, defined by the Medicare Hospice Regulations as having "a medical prognosis with a life expectancy of 6 months or less if the disease follows its normal course, as certified by a physician." Medicare Part A covers the Hospice Benefit, which consists of four levels of care: routine home care, hospice inpatient care, continuous care and respite care. Medicare beneficiaries who are HMO members are entitled to use their Hospice Benefit and may choose any hospice provider while remaining an HMO member. Federal regulations require certification periods for Hospice Medicare and Medicaid patients, which consist of an initial 90-day period, a subsequent 90-day period, followed by an unlimited number of 60-day periods. At the conclusion of each benefit period, the Hospice Nurse will reassess and a Physician will re-certify the patient's continued eligibility for the Hospice Medicare or Medicaid Benefit. The patient may elect to stop hospice services at any time and revert to his/her previous Medicare benefit. Any remaining days in a hospice benefit period are forfeited once hospice care is stopped. However, a patient can re-elect the next benefit period at any given time. If a patient no longer meets the requirements to be eligible for the Hospice Medicare or Medicaid Benefit, members of the Hospice Team will assist in reinstating the patient's regular Medicare or Medicaid benefits. They will also make sure the patient and family are referred to the appropriate healthcare provider. If you have any questions, please ask your Nurse. Hospice care is available to anyone regardless of age or financial status. Remember, hospice coverage is for the life-limiting illness only. Any other illness or diagnosis not related to the life-limiting illness is handled under the patient's regular Insurance plan.

Private Insurance

Most Insurance plans provide a hospice benefit similar to Medicare. Hospice staff are available to assist in verifying Insurance coverage for hospice services. Remember, hospice coverage is for the life-limiting illness only. Any other illness or diagnosis not related to the life-limiting illness is handled under the patient’s regular Insurance plan.

Hospice of Palm Beach County staff is available to assist with Medicare and other insurance issues. Call (888) 848-5200 or (561) 227-5294 direct.

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