The Medicare Hospice Benefit Explained

Congress established the Medicare Hospice Benefit in 1983 to ensure that all Medicare beneficiaries could access high-quality end-of-life care. The Medicare Hospice Benefit covered 85.5 percent of hospice patients in 2014. The Medicare Hospice Benefit offers dying Americans the option to experience death free of pain, with emotional and spiritual support for both themselves and their families.

Care that patients receive under the Medicare Hospice Benefit for their terminal illness must be from a Medicare-approved hospice program. Hospice of the Red River Valley is Medicare certified and licensed in both Minnesota and North Dakota. Often, we hear questions about the Medicare Hospice Benefit:

Who qualifies for hospice care under Medicare?
To be eligible to elect hospice care under Medicare, an individual must meet all of the following:

  • He/she is eligible for Medicare Part A.
  • He/she has a life expectancy of six months or less if the disease runs its normal course.
  • He/she has chosen hospice care instead of other Medicare-covered benefits.
  • He/she gets care from a Medicare-certified hospice.

What is covered under the Medicare Hospice Benefit?
The Medicare Hospice Benefit pays all expenses related to hospice care, including:

  • Hospice services, including medical, emotional, spiritual care
  • Medical equipment and supplies
  • Medications for pain and symptom control related to the terminal illness
  • Physical therapy, occupational therapy, speech and dietary consultations
  • Grief support for 13 months after the death
  • Short-term inpatient care
  • Short-term respite care

Note: Medicare payments to hospice do not interfere with Medicare payments for other illnesses or conditions.

What will Medicare NOT pay for?
The following is not covered under the Medicare Hospice Benefit:

  • Any treatment intended to cure your illness
  • Prescription drugs needed for other than pain and symptom management
  • Room and board
  • Care from any other provider*
  • Care in the emergency room*
  • Care in an inpatient facility*
  • Ambulance transportation*
    *Unless pre-approved by the hospice team

How are hospice services paid for by Medicare?
Hospice is reimbursed by Medicare at a per diem (daily) rate that is determined by where the patient resides and the level of care required (routine home care, continuous/concentrated home care, general inpatient and inpatient respite). Hospice receives the payment directly from Medicare.

Medicare and insurance can be complicated. No matter what your payment source, our insurance specialist will contact your insurance company to ensure you receive the benefits to which you are entitled. With Hospice of the Red River Valley, no patient is denied services because of an inability to pay; we provide services to anyone who meets the medical guidelines for hospice care.

For answers to questions about your specific situation, please contact us at (800) 237-4629 or questions@hrrv.org.

Note: This article last updated on 4-4-17.

About Hospice of the Red River Valley
Hospice of the Red River Valley is an independent, not-for-profit hospice serving all, or portions of, 29 counties in North Dakota and Minnesota. Hospice care is intensive comfort care that alleviates pain and suffering, enhancing the quality of life for patients with life-limiting illnesses and their loved ones by addressing their medical, emotional, spiritual and grief needs. For more information, call toll free 800-237-4629, email questions@hrrv.org or visit www.hrrv.org.