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Medicare Hospice Qualifications


What is Medicare Hospice?
How long will they help me?
Who Is Eligible For Hospice? What do I have to pay?
How Hospice works? Volusia County Hospice Agencies
What is Respite Care?  

Information based on CMS national coverage determination. This information is a guide only and in no way guarantee's coverage. Florida Medicaid Policies may be different.

What is Hospice?


Hospice is a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. Hospice care is given by a public agency or private company approved by Medicare. It is for all age groups, including children, adults, and the elderly during their final stages of life.


The goal of hospice is to care for you and your family, not to cure your illness. If you qualify for hospice care, you can get medical and support services, including nursing care, medical social services, doctor services, counseling, homemaker services, and other types of services (see page 5). You will have a team of doctors, nurses, home health aides, social workers, counselors and trained volunteers to help you and your family cope with your illness. In many cases, you and your family can stay together in the comfort of your home. Depending on your condition, you may have hospice care in a hospice facility, hospital, or nursing home.


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How do I qualify for Hospice Care Services?


Hospice care is covered under Medicare Part A (Hospital Insurance). You are eligible for Medicare hospice benefits when:


You are eligible for Medicare Part A (Hospital Insurance);
and
Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live;
and
You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness*;
and * Medicare will still pay for covered benefits for any health problems that are not related to your terminal illness (see page 10 “Can I keep my Medicare health plan?”).

You receive care from a Medicare-approved hospice program.

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How Hospice works?


Your doctor and the hospice will work with you and your family to set up a plan of care that meets your needs. The plan of care includes the hospice services you need that are covered by Medicare. The chart on page 5 lists these hospice services, including grief and loss counseling for your family. For more specific information on a hospice plan of care, call your State Hospice Organization

The care that the hospice gives you is meant to help you make the most of the last months of life by giving you comfort and relief from pain. The focus is on care, not cure. As a hospice patient, there is a team of people that will help take care of you. They are . . .


  • your family
  • a doctor
  • a nurse
  • clergy or other counselor
  • a social worker
  • trained volunteers
Volunteers are trained to help with everyday tasks, such as shopping and personal care services, like bathing and dressing. Speech, physical, and occupational therapists and other persons who are trained to give care are also there for you when needed. A family member or other person who cares for you will be with you every day and members of the hospice team will make regular visits. A nurse and a doctor are on-call 24 hours a day, 7 days a week to give you and your family support and care when needed. If you should need care in a hospital for your illness, the hospice team will help arrange your stay. Even though a doctor is a part of the hospice team, you can choose to use your regular doctor, who is not a part of the hospice, to get care. The hospice will work closely with your regular doctor to give you the care that you need.

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What is Respite Care?


Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. As a hospice patient, you may have one person that takes care of you every day. That person might be a family member. Sometimes they need someone to take care of you for a short time while they do other things that need to be done. During a period of respite care, you will be cared for in a Medicare-approved facility, such as a hospice facility, hospital or nursing home.

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How long will they help me?


You can get hospice care as long as your doctor certifies that you are terminally ill and probably have less than six months to live. Even if you live longer than six months, you can get hospice care as long as your doctor recertifies that you are terminally ill. Hospice care is given in periods of care. As a hospice patient, you can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods. At the start of each period of care, your doctor must certify that you are terminally ill in order for you to continue getting hospice care. A period of care starts the day you begin to get hospice care. It ends when your 90 or 60-day period is up. If your doctor recertifies that you are terminally ill, your care continues through another period of care. Note: Periods of care are important. They are a time when your doctor recertifies that you still need and remain eligible for hospice care.

As a hospice patient, why would I stop getting hospice care? Sometimes a terminally ill patient’s health improves or their illness goes into remission. If that happens, your doctor may feel that you no longer need hospice care and will not recertify you at that time. Also, as a hospice patient you always have the right to stop getting hospice care, for whatever reason. If you stop your hospice care, you will get your health care from your Medicare health plan, (like the Original Medicare Plan or a Medicare managed care plan). If you are eligible, you can go back to hospice care at any time. As a hospice patient, you always have the right to stop getting hospice care and go back to your regular doctor or health plan.

Example: Mrs. Jones is a cancer patient who received hospice care for two 90-day periods of care. Mrs. Jones’ cancer went into remission. At the start of her 60-day period of care, Mrs. Jones and her doctor decided that, due to her remission, she would not need to return to hospice care at that time. Mrs. Jones’ doctor told her that if she becomes eligible for hospice, she may be recertified and can return to hospice care.

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What do I have to pay?


What will I have to pay for hospice care? Medicare pays the hospice for your hospice care. You will have to pay:


No more than $5 for each prescription drug and other similar products: The hospice can charge up to $5 for each prescription for outpatient drugs or other similar products for pain relief and symptom control.

5% of the Medicare payment amount for inpatient respite care: For example, if Medicare pays $100 per day for inpatient respite care, you will pay $5 per day. You can stay in a Medicare-approved hospital or nursing home up to 5 days each time you get respite care. There is no limit to the number of times you can get respite care. The amount you pay for respite care can change each year.

Can I keep my Medicare health plan? Yes. You should use your Medicare health plan (like the Original Medicare Plan or a Medicare managed care plan) to get care for any health problems that are not related to your terminal illness. You may be able to get this care from your own doctor who is not a part of the hospice, or from the hospice doctor. When you use your Medicare health plan, you must pay the deductible and coinsurance amounts (if you have the Original Medicare Plan), or the co-payment (if you have a Medicare managed care plan). For more information about Medicare health plans, including deductibles, coinsurance, and co-payments, look in your Medicare & You handbook. If you do not have the Medicare handbook, you can get a free copy by calling 1 800 633 - 4227 (TTY/TDD: 1 877 486 - 2048 for the speech and hearing impaired).

Important information about Medicare Supplemental Insurance: If you are in the Original Medicare Plan, you may have a Medicare Supplemental Insurance or “Medigap” policy. Your Medigap policy still helps to cover the costs for the care of health problems that are not related to your terminal illness. Call your insurance company for more information. You can also call 1 800 633 - 4227 (TTY/TDD: 1 877 486 - 2048 for the speech and hearing impaired) and ask for a free copy of the Guide to Health Insurance for People with Medicare. This guide will give you more information on using Medigap policies.


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List of Volusia County Hospice


Florida Hospital HospiceCare
770 West Granada Boulevard, Suite 304
Ormond Beach, Florida 32174
(386) 671-2138
Aleda Kleckauskas, Administrative Director
E-mail:aleda.kleckauskas@fhms.org
Website: www.fhhospicecare.org

Odyssey HealthCare Daytona
149 South Ridgewood Avenue, Suite 400
Daytona Beach, Florida 32114
(386) 248-2380
(866) 853-2380
Rema Cole, General Manager
E-mail: rcole@odsyhealth.com
Website: www.odsyhealth.com

The Hospice of Volusia/Flagler

3800 Woodbriar Trail
Port Orange, Florida 32129
(386) 322-4701
(800) 272-2717
Fran Davis, Executive Director
E-mail: fran.davis@halifax.org
Website: www.hfch.org/hospice

VITAS Innovative Hospice Care® of Volusia/Flagler
533 North Nova Road, Suite 206
Ormond Beach, FL  32174
386.671.2792
888.250.9535
Jennifer Nygaard, General Manager
E-mail: jennifer.nygaard@vitas.com
Website: www.vitas.com


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