QUESTIONS & ANSWERS
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How long is someone eligible for hospice services? A patient can have hospice care as long as the medical provider and hospice team determine the patient continues to meet Medicare guidelines and the patient continues to choose comfort care. The hospice team can make referrals to other agencies if a patient is no longer eligible for hospice servic- es. If a patient is discharged from hospice either for medical reasons or by patient choice, they can be readmitted to hospice care at a later time if the patient meets eligibility requirements. What is a benefit period? The Medicare Hospice Benefit consists of two 90- day benefit periods followed by an indefinite num- ber of 60-day benefit periods. At the end of each period, the hospice team must agree that the pa- tient continues to be terminally ill. If the patient is improving or the illness has stabilized, the hospice team will discuss alternatives to hospice care with the patient and family. What if I stop hospice care before a period is over? Medicare allows the patient to discontinue their Medicare Hospice Benefit at any time. If a patient re-elects their Medicare Hospice Benefit, they be- gin their next benefit period. If they resume hos- pcie services in their 3rd or later benefit period, Medicare requires that they have a face-to-face visit either in-person or via telehealth with a hos- pice medical provider prior to readmission. How does the Medicare Hospice Benefit cover hospitalization? If a patient has symptoms that are difficult to manage at home, a few days in a hospital or inpatient hospice unit may be necessary. The need for this must be as- sessed by a hospice nurse. The types of problems that may warrant a stay in the hospital or inpatient hospice unit like Elizabeth House are increased pain, uncon- trolled nausea, vomiting, or shortness of breath. If an inpatient stay is needed, the hospice team will help you arrange transportation. The Medicare Hospice Benefit requires the pre-authorization of any hospital stay or emergency room visit related to the terminal illness. Please remember to call hospice day or night!
How is my medical provider paid? Medicare Part B will continue to cover the cost of your medical provider’s visits. Any labs or proce- dures you have in your medical provider’s office that are related to your terminal illness must be preapproved and will be paid for by hospice. Does Medicaid cover hospice services? Yes, the Medicaid Hospice Benefit provides the same coverage as Medicare. Your Medicaid card will be used to confirm your eligibility for this benefit. Medic- aid asks that we verify eligibility every month as well. How can the caregiver get a break? Short breaks of an hour or two can be arranged with the help of a volunteer. If a longer break is necessary, a period of up to five days can be ar- ranged by the nurse or social worker at a contract- ed facility or inpatient hospice unit like Elizabeth House. This “break” is referred to as respite. Con- sider respite care if there is a family emergency, a need for the caregiver to go away, or as a needed break from caregiving. What hospice benefits are available through my private insurance? Many private insurance carriers include hospice coverage in their program. We will obtain your insurance information from you and contact the insurance company regarding the coverage. Con- tact your hospice team if you have any questions regarding your insurance coverage. Please con- tact your primary nurse with any changes to your healthcare coverage. Will I have to pay a co-pay or deductible? Four Seasons will bill you for any amount applied toward your personal deductible and/or co-pay after the partial payment has been received from your insurance company. If a person has no insurance, will hospice and palliative care be available? It is our mission to provide comfort care regardless of the ability to pay. Thanks to the generosity of our donors, we’re able to provide services to all pa- tients who need them. Contact our billing depart- ment if you need to discuss payment options or have concerns related to your insurance coverage.
PAYING FOR CARE
QUESTIONS & ANSWERS
Four Seasons operates a nonprofit, community-based, Medicare-certified hospice program. How are hospice services paid?
fied daily rates for care provided. Therefore, Four Seasons delivers care based on the plan of care and is not responsible for care obtained by the patient outside of this plan of care. Remember that these restrictions apply to the terminal illness and relat- ed diagnoses. Unrelated medical problems may be treated in your usual manner with your insurance coverage. Always check with your hospice nurse first before going to the hospital, other appointments, or starting a new medication. Who is eligible for this benefit? • The patient who has Medicare Part A or full Med- icaid coverage. • The patient whose doctor has confirmed the termi- nal condition. • The patient who chooses to focus on symptom management rather than curative care. • The patient who signs a statement choosing hos- pice care benefits. • The patient who receives care from a Medicare- approved hospice. • The patient who has months rather than years to live.
Four Seasons’ services are covered through Medi- care, Medicaid, and many private insurance plans. Medicare pays hospice directly for each day hos- pice is responsible for care. During hospice care, you should not receive a bill from Medicare for hospice or any related service. If any questions come up regarding billing, ask your nurse or social worker for help. Thanks to the generosity of our donors, we’re able to provide services to all pa- tients who need them through the Four Seasons Foundation, as well. What is the Medicare/Medicaid Hospice Benefit (MHB)? Our hospice is certified as a Medicare/Medicaid pro- vider. Patients who meet the admission criteria and are Medicare/Medicaid eligible can elect this ben- efit. In addition to the services already mentioned the Medicare Hospice Benefit provides medications, medical equipment and supplies, inpatient hospice care, hospitalization pre-approved by hospice team
Trusted Collaboration.
and respite care for caregiver relief. What is pre-authorization?
All services, medications, supplies, or equipment re- lated to the terminal illness for which hospice has been ordered must be pre-authorized by Four Sea- sons. Medicare pays Four Seasons directly at speci-
866.466.9734
FourSeasonsCare.org
FourSeasonsCare.org
866.466.9734
Four Seasons
Four Seasons
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