Does Medicare Cover Hospice in Florida?

Medicare provides coverage for hospice care in Florida. Hospice care is a specialized approach focused on providing comfort and support for individuals facing a terminal illness. The goal is to enhance the quality of life for the patient and family. This care addresses physical, emotional, and spiritual needs, allowing patients to live their remaining days with dignity and peace.

Eligibility for Medicare Hospice Coverage

To qualify for Medicare’s hospice benefit, an individual must meet specific criteria. A physician must certify that the patient is terminally ill, indicating a medical prognosis of six months or less to live. This certification typically requires the involvement of both the patient’s attending physician and a hospice medical director.

A patient must also be enrolled in Medicare Part A, which covers hospital insurance. The individual needs to make a conscious choice to receive hospice care, electing palliative care for comfort and symptom management instead of continuing curative treatments for their terminal illness. This election signifies an understanding that the focus of care shifts from curing the illness to providing comfort and support.

Covered Hospice Services

Medicare’s hospice benefit encompasses a wide array of services delivered through a team-oriented approach, ensuring comprehensive care for the patient and support for their family. This includes physician services, nursing care, medical equipment such as wheelchairs or walkers, and medical supplies like bandages or catheters. Prescription drugs for pain and symptom management related to the terminal illness are covered.

The benefit further extends to therapies, including physical, occupational, and speech-language pathology services, social work services, dietary counseling, and spiritual counseling. Grief and bereavement counseling are provided for the patient’s family. Hospice care can be delivered in various settings, including the patient’s home, a nursing home, or an inpatient hospice facility. Medicare also covers different levels of hospice care:

• Routine home care
• Continuous home care during crisis periods
• Inpatient respite care for caregiver relief
• General inpatient care for acute symptom management

Patient Financial Responsibilities

Medicare generally covers 100% of hospice costs, meaning beneficiaries typically have no deductible or copayment for care provided by a Medicare-approved hospice. However, a patient may incur minor out-of-pocket expenses. A small copayment for prescription drugs used for pain and symptom management is capped at $5 per prescription.

Another potential cost involves inpatient respite care, which provides short-term inpatient stays for caregiver relief. For this service, a patient may be responsible for a 5% coinsurance. Medicare hospice does not cover treatments intended to cure the terminal illness, care from providers not arranged by the hospice team, or the cost of room and board if the patient’s primary residence is a nursing home or other facility, unless the stay is for general inpatient care or respite care.

Accessing and Managing Your Hospice Benefit

Initiating the Medicare hospice benefit begins with a discussion between the patient or their family and their physician, who can then make a referral to a hospice provider. Patients or their representatives must then choose a Medicare-approved hospice provider in Florida and sign an election statement to formally begin the benefit. This statement identifies the chosen hospice and acknowledges the shift to comfort-focused care.

Medicare’s hospice benefit periods are structured to allow for ongoing care as long as the patient remains eligible. This includes two initial 90-day periods, followed by an unlimited number of 60-day periods. Each of these benefit periods requires a physician certification to confirm the patient continues to meet the eligibility criteria. If a patient wishes to change hospice providers, they are permitted to do so once during each benefit period. Patients also have the right to revoke their hospice benefit at any time if they choose to pursue curative treatment, and they can re-elect the benefit later if their circumstances change and they again meet eligibility requirements. Resources such as the Medicare.gov “Find & Compare” tool can assist in locating Medicare-approved hospice providers throughout Florida.