How does it work?

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What Is Covered By The Payor?
(Medicare, Medicaid, Or Private Insurance)

Hospice benefits provide these hospice services for a patient’s terminal illness and related conditions:

  • Physician services
  • Nursing care
  • Medical equipment (such as wheelchairs or walkers)
  • Medical supplies (such as bandages and catheters)
  • Drugs for symptom control and pain relief
  • Home health aide services
  • Physical and occupational therapy
  • • Speech therapy
  • Social worker services
  • Dietary counseling
  • Bereavement counseling for the patient and their family
  • Short-term inpatient care
  • Short-term respite care
  • Any other covered services needed to manage pain and control symptoms, as recommended by the hospice team

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What Is Not Covered?

When hospice care is chosen, the following items are normally no longer covered:

  • Treatment intended to cure the terminal illness
    A patient should consult with their doctor if they are considering getting treatment to cure their illness. Any hospice patient always has the right to stop getting hospice care at any time and receive the coverage they had before they began receiving hospice care.

  • Prescription drugs intended to cure the terminal illness
    Only the drugs used to provide symptom control and pain relief are covered. If a patient is enrolled in prescription drug coverage, however, drugs unrelated to the terminal illness normally remain covered.

  • Room and board
    Room and board aren’t covered if the patient is receiving hospice care in a nursing home unless the nursing home stay is related to short-term inpatient or respite services that the hospice medical team determines are needed.

  • Other
    The following services are not covered unless they have been arranged in
    advance by the hospice medical team:

    • Emergency room care
    • Care in an inpatient facility
    • Ambulance transportation
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How Much Does The Patient Have To Pay For Hospice Care?

Although the guidelines dictated by Medicare, Medicaid, and private insurance providers normally specify a co-pay from the patient for such things as respite care and pharmaceuticals, Hospice of the Shoals never requires patients to make such payments.

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How Would Care For A Condition Other Than The Terminal Illness Be Covered?

A patient can continue to use their benefit plan to receive care for any health problems that aren’t related to their terminal illness. They can also still use their own doctor for this care.

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How Long Can A Patient Receive Hospice Care?

A patient can benefit from hospice care as long as their doctor and the hospice medical director certify that they are terminally ill and probably have six months or less to live if the disease runs its normal course. Even if they live longer than six months, they can still receive hospice care, as long as the hospice medical director recertifies that they are still terminally ill.

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Why Would Someone Stop Getting Hospice Care?

If a patient’s health improves or if their illness goes into remission, they may no longer need hospice care. Also, any patient always has the right to stop getting hospice care for any reason. If a patient decides to stop their hospice care, they normally may return to the type of coverage that they had before they chose a hospice program. If they are eligible, they can begin receiving hospice care again at any time.

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What Is Respite Care?

While in hospice care, a patient may have one person who takes care of them every day, such as a family member. Sometimes this person needs someone to take care of the patient for a short time when he or she needs a break from caregiving. Respite care is care given to a hospice patient by another caregiver such as a nursing home or other inpatient facility so that the primary caregiver(s) can rest.

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