What Is Covered Under Hospice?

The biggest misconception:
Hospice staff will be there all day or even 24 hours a day.

If you or your loved one needs around the clock care, the hospice Social Worker will help you find individuals you can hire or a facility that can provide the care needed. HOSPICE DOES NOT COVER AROUND THE CLOCK CARE OR ROOM AND BOARD IN A NURSING HOME.

What is covered under the Hospice Benefit?

ServicesMedicarePrivate Insurance
ChemotherapyGenerally, NOT Covered: Considered curative treatment. Some hospices make allowances.Generally, NOT Covered: Considered curative treatment. Some hospices make allowances
Dietary CounselingCoveredCheck policy
Grief and loss counseling for you and your familyCovered: including 12 months after death of loved one.Covered
Homemaker Services (assistance with personal hygiene, essential shopping, laundry, light housekeeping, light meal preparation)NOT CoveredNOT Covered
Hospice Certified Nursing Assistant (CNA)Covered: limited, intermittent care with “hands on personal care”.Covered: part time or intermittent for “hands on personal care”
Inpatient Care- short stayCovered: with prior approval from hospice, requires physician’s order and must be needed for a temporary medical problem. For symptom management ONLY. This is NOT a substitution for nursing home care or when a family is no longer able to provide care.Check policy
Intravenous (IV) TherapyNot covered for hospice diagnosisNot covered
Medical EquipmentOnly if related to hospice diagnosisCheck policy
Medical SuppliesOnly if related to hospice diagnosis; Wipes not includedOnly if related to hospice diagnosis
Medical Transport - ambulanceRequires prior approval by hospice and must be related to hospice diagnosisCheck policy
Medications for symptom management and pain reliefCovered: only if related to hospice diagnosisCovered: using prescription plan program.
Nursing Facility StaysCovered: does not pay for room and board portion of nursing home careCovered: does not pay for room and board portion of nursing home care
Nursing medical management and home visitsCovered: on-call Registered Nurse (RN) available 24/7On-call RN available 24/7
Occupational TherapyCovered- visits limited; must be ordered by physicianCheck policy
OxygenCovered: must be related to hospice diagnosis and ordered by physicianCovered: must be related to hospice diagnosis and ordered by physician
Physical TherapyCovered: visits limited and must be ordered by physician.Check policy
Physician servicesCovered: Medical Director may make home visits.Covered: Medical Director may make home visits.
Psychosocial Services- Social WorkerCoveredCovered
Respite care- 5 days/ 4 nights (not in home, usually at a nursing home that has 24 hour nurses on staff)CoveredCheck policy
Around the Clock CareONLY in specific circumstances for short period; called “continuous Care”; must be ordered by a physicianCheck policy
Speech- language PathologyCovered: only a few visits and must be ordered by physicianCheck policy
Spiritual CareCoveredCovered
TransfusionsGenerally not covered and not allowed. Each hospice decides on a case-by-case basis. Considered curative treatment.Generally not covered and not allowed. Each hospice and insurance carrier decides on a case-by-case basis. Considered curative treatment.
Visits to the ERCOVERED: IF APPROVED IN ADVANCE BY HOSPICE AND RELATED TO HOSPICE DIAGNOSISCOVERED: IF APPROVED IN ADVANCE BY HOSPICE AND RELATED TO HOSPICE DIAGNOSIS
Visits to a SpecialistCOVERED: IF APPROVED IN ADVANCE BY HOSPICE AND RELATED TO HOSPICE DIAGNOSISCheck policy
Visits to your physicianCOVERED: IF APPROVED IN ADVANCE BY HOSPICE AND RELATED TO HOSPICE DIAGNOSISCheck policy

Links:

Caring connection: http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3299