Hospice Eligibility and Qualification

As life begins to pass by, one may wonder whether they or a loved one need to be cared for by 5 Star Hospice Home Care. It may be getting too hard for you or a loved one to care for themselves and they may need extra help to do so. Caregivers, such as family members or friends, may need professional help to provide the necessary care. Our program and health care abilities are here to help alleviate that stress, proving the patient with the best care to ensure that they are comfortable and that their pain is managed. Specifically, hospice care is for individuals who are nearing the end of their life as a result of a terminal illness. The advanced nature of some of these illnesses may make the patient eligible for hospice care.

What Illnesses make a Patient Eligible?

A snapshot of these diseases includes but are not limited to Alzheimer’s disease, cancer, cardiovascular disease, dementia, HIV/AIDS, liver disease, and Parkinson’s disease.

Please note, there are many other types of illnesses that may qualify for you or a loved one. To find out, contact us for more information regarding the specific illness in question. Remember, we are here to help! If you have any questions, we are available to answer them all 24/7.

Who Determines a Person’s Eligibility?

The patient’s personal physician who is caring for the patient and our hospice physician work in alongside one another to help decide whether the person is ready for hospice care or not. Also, as the patient’s family, you play a role in the overall decision making. If certain symptoms are arising in conjunction with the knowledge of the patient’s terminal illness and limited life expectancy, it may be best to discuss these concerns with the patient’s physician’s or contacting 5 Star Hospice. It is important to keep in mind that even though loved ones should advocate for them, Medicare only allows the patient’s physician and hospice physician to certify their eligibility for hospice care.

What Symptoms May Indicate Hospice Home Care is Needed?

There are certain signs and symptoms that one should be aware of that would aid in deciding whether hospice care is right for you or a loved one. If you or someone you love is experiencing fatigue or weakness that never really goes away, has a decreased appetite or no appetite at all, difficulty swallowing, weight loss, malnutrition, difficulty doing day to day activities, recurrent infections, and recurring hospitalization, they may be eligible for our home hospice care services.

Hospice Qualification: Who Pays?

Although our eligibility guidelines are a bit more open-ended, the agencies in charge of helping patient’s pay for their care have guidelines with less wiggle room. Typically, most insurance providers and agencies require a physician’s diagnosis that states that the patient has a terminal illness and has a life expectancy of 6 months or less. However, this isn’t the sole determinant and each case is unique. Keep in mind that hospice care aims to be affordable for both the patient and the patient’s family. In some cases, providers cover 100 percent of the costs.

Medicare & Hospice

Hospice care costs are most commonly covered by Medicare. Medicare is a national or federal health insurance program that individuals aged 65 years or older, young individuals with a disability, or people with End-Stage Renal Disease are eligible for. Medicare has different parts that help to cover the different aspects of health care. Specifically, there is Medicare Part A, B, C, and D. For our purposes, we will be focusing on Medicare Part A and C as it is the Hospital Insurance that covers Hospice Care. Medicare Part C, also known Medicare Advantage covers all the benefits of all the plans combined. If you or a loved one is unsure as to what coverage they have, call the numbers available on your insurance cards to clarify. If you or someone you love may need hospice care but is not covered by Medicare and instead by a private insurance company, contact the provider to see what they do and do not cover. If the person is uninsured, all hope is not lost as some hospice care programs are able to cover costs thanks to donations and grants. Again, it is best to contact these programs specifically with questions.

Does Medicare Pay for Hospice Care?

According to Medicare’s website, their Part A coverage offers Medicare as a benefit, meaning they cover the costs of hospice if the patient’s doctors decide that such care is necessary. Since Part C is advertised as an all-included type package, those under that plan’s coverage also qualify to have their hospice care costs covered. To fully qualify, the patient’s doctors must certify that the patient has a terminal illness causing a life expectancy of 6 months or less, a loved on must certify that they are choosing hospice and no other treatment for the terminal illness, and the hospice care provider must be approved by Medicare. All aspects of hospice care are not paid for and these include prescription co-pays and 5 percent of Medicare-approved inpatient respite care.

success smart medical doctor working with operating room

Does Medicare cover all care?

The short answer is no. While Medicare covers the costs of many different types of care that fall under the hospice care umbrella, there are stipulations in place that dictate what will and will not be covered. With that said, all areas that the patient needs are covered are meant to protect the patient and their families. To avoid surprises, read below.

What Medicare Covers

Medicare covers a long list of things for a patient which include doctor services, nursing care, durable medical equipment like wheelchairs and walkers, medical supplies like bandages, prescription drugs for pain or symptom management, nutritional counseling, hospice aide and homemaker services, physical therapy, grief or loss counseling for the patient’s loved ones, social worker services, short-term inpatient care, and short-term respite care for caregivers. As can be previously, Medicare aims to cover a person’s care in its entirety with little out of pocket financial strain on both the patient or the patient’s loved ones.

What Medicare does not Cover

The list of what Medicare will not cover is a bit shorter. Medicare will not cover any treatment that is intended to cure the terminal illness. Also, care from any hospice provider that wasn’t arranged by the hospice medical team is not covered. Unless the hospice care provider that is Medicare-approved has been officially changed, no other provider is able to administer any care. ALL care must be given by the medical hospice team of the certain provider. Furthermore, room and board are not covered, meaning rent or fees that are charged by an assisted living facility or home are paid by Medicare. Lastly, emergency care is not covered unless arranged by the medical hospice team. Any care unrelated to the terminal illness is also not covered, meaning if an emergency room visit is necessary for something not related to the patient’s illness, it will not be covered.

Hospice care is covered by most insurance providers and Medicare and is aimed to be affordable so that the patient’s comfort and care are at the forefront of the family’s and providers concern. Any questions regarding eligibility or qualification that weren’t answered above are best directed to either us at 5 Star Hospice, the patient’s personal doctor, or your insurance providers. We are available 24/7 to help you with all your needs.


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