Paying for Hospice
Good Shepherd Hospice care is provided by your hospice team based upon what is called a “plan of care”. That plan will determine the number of visits based on you and your family’s needs. Most of our hospice care is covered under the Medicare Hospice Benefit, meaning that if the patient is of a certain age and is qualified, then the hospice care we deliver will be paid for by Medicare or Medicaid. In some cases, those not in the government-sponsored programs will be covered under their group insurance plans from work. And for others who qualify based upon low or no income, there may be an assistance program that will pay for services.
By choosing Good Shepherd Hospice, you can trust we will work with all who choose our services so that the expense of care doesn’t get in the way of receiving the care you deserve.
Many of our Good Shepherd Hospice patients are in their own homes, but if a patient desires to reside in an area nursing home, the cost of living in that facility is not covered under the hospice benefit. This means you or a family member will meet with the nursing home staff to discuss the out of pocket payment that is required for admission to their facility. If you are eligible for Medicaid, Medicaid will cover room and board charges.
Medicare Hospice Benefit
The Medicare Hospice Benefit is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of medical and support services for their life-limiting illness. Good Shepherd Hospice care also supports the family and loved ones of the person through our social workers, chaplains and bereavement counselors.
Good Shepherd Hospice is certified by Medicare. People over the age of 65 who are entitled to the services offered by the Medicare Hospice Benefit are fully covered for all of the care related to the terminal illness (and related illness) that is determined medically necessary by the hospice physician.
REMEMBER: When you choose Good Shepherd Hospice, we will help you manage your healthcare planning. Should there be a medical condition that is not related to the terminal illness diagnosis or related illness, then the Medicare coverage you had before electing the hospice benefit will cover these illnesses and their treatment.
Should your health improve or your illness go into remission, your hospice physician may feel that you no longer need hospice care. If this happens, then your hospice physician and your primary physician will discharge you from hospice and return to the care and the Medicare coverage you had before electing the hospice benefit.
Also, it is important that you know you always have the right to stop receiving hospice care at any time and for any reason. If you stop your hospice care, you will receive the type of Medicare coverage that you had before electing hospice. Then, if appropriate, you can choose to go back to hospice care at any time in the future.
Who is Eligible for Medicare Hospice Benefits?
You are eligible for Medicare hospice benefits when you meet all of the following conditions:
You are eligible for Medicare Part A (Hospital Insurance), and
Your doctor and the hospice medical director certify that you have a life-limiting illness and if the disease runs its normal course, death may be expected in six months or less, and
You sign a statement choosing hospice care instead of routine Medicare covered benefits for your illness*, and
You receive care from a Medicare-approved hospice program
*Medicare will still pay for covered benefits for any health needs that aren’t related to your life-limiting illness or related illnesses.
What Does Medicare Cover?
Medicare defines a set of hospice services that Good Shepherd Hospice is required to provide these set of services to each person they serve, regardless of the person's insurance.
Medicare covers these hospice services and pays nearly all of their costs:
Home health aide and homemaker services
Social work services
Therapy services (physical, occupational and speech therapy as determined medically necessary by hospice physician)
Medical equipment (like wheelchairs or walkers)
Medical supplies (like bandages and catheters)
Drugs for symptom control and pain relief
Short-term care in the hospital or skilled nursing facility for pain and symptom crisis management
Inpatient respite for caregiver relief
Short-term hourly care in the home for a pain and symptom, which we refer to as crisis management
Grief support to help you and your family during and after hospice services
The Medicare Hospice Benefit Does Not Cover the Following:
Treatment intended to cure your illness.
You will receive comfort care to help manage symptoms related to your terminal illness. Comfort care includes medications for symptom control and pain relief, physical care, counseling, and other hospice services.
Medications not directly related to your hospice illness or related illnesses.
Hospice team members will consult with the hospice physician and will tell you and your family which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit. The Hospice uses medicine, equipment, and supplies to make you as comfortable as possible. Under the hospice benefit, Medicare won’t pay for treatment where the goal is to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. You always have the right to stop at any time to seek curative care.
Care from another provider when you elect your Hospice Benefit.
All care that you receive for your terminal illness or related illnesses must be approved and provided by your hospice team. If you receive care for your terminal illness or related illnesses without hospice approval, you could be liable for the cost.