Home Health vs. Hospice

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There are two types of home medical services available to the seriously ill, Home Health and Hospice.  Most families are surprised to learn that the care provided by home health or hospice is covered by most private insurance plans, and almost entirely covered by Medicare.

Home Health - Eligibility Requirements

• The focus of home health is Rehabilitative and Curative Care

• The patient must be home-bound (can leave the home if it requires a taxing effort and if it is infrequent)

• The patient must have need for skilled care – Skilled Nursing, Physical Therapy, Speech Therapy, or Occupational Therapy

• An order for home health must be written by a physician who plans to follow the patient during the episode of home health.

 

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Home Health - Cost and Insurance Coverage

• Most private insurance as well as Medicare will cover home health costs. Please check with your insurance company or have your physician’s office check for you.

• Covered costs are for the actual visits for services and for most supplies. Medications may be covered under the prescription benefits of any particular plan but are not paid for by the home health agency.

• Social worker services are provided to home health patients by the agency and are also typically covered by insurance.

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Hospice - Eligibility Requirements

Currently, the legislature has established very specific criteria for Medicare recipients to receive full hospice coverage.

    • A doctor must prescribe hospice on the basis of his/her belief that the patient is unlikely to live more than six months. (This does not mean that the patient is going to die in six months. Many hospice patients live for months or even years longer! It simply means that the patient has a serious, life-threatening condition.)
    • The patient prefers a focus on staying comfortable rather than a focus on cure. The typical hospice patient is an individual whose emphasis is on quality of life. Instead of dealing with curative therapies and their often exhausting and distressing side effects with slim chance of success, hospice patients choose to let nature take its course. They focus on medications and therapies that will allow them to comfortably engage in the activities they enjoy for as long as possible. Medicare will not pay for curative care and hospice care at the same time.

Private insurance companies often mirror Medicare and Medicaid’s eligibility requirements, although a very few will pay for curative and hospice care simultaneously, especially in the case of seriously ill children. Check with your insurance carrier to find out about their criteria, or give us a call at 901-767-6767, or toll-free 800-727-6416.

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Hospice - Cost and Insurance Coverage

Hospice is one of very few services that are covered up to 100% by Medicare. For many families, this means there is no deductible and there are no co-payments. Provided other eligibility requirements are met, Medicare will pay for home visits and all medications, supplies, and equipment related to easing pain or uncomfortable symptoms. In most instances, Medicare will even pay for several days a month in a nursing home or in a general inpatient facility or hospice house if family members need a break. Medicare may even pay for hospice services provided in conjunction with a longer nursing home stay. Contact us at 901-767-6767, or toll-free 800-727-6416 or trinityhospiceinfo@bmhcc.org for more information.

For individuals with private insurance, check with your insurance carrier regarding hospice benefits. Typically they cover the same services, medications, supplies, and equipment as the Medicare program. Some follow the same eligibility requirements as Medicare; others have their own eligibility criteria.

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