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Eligibility

Hospice Eligibility & Qualifications

Hospice Care Eligibility

How is hospice care paid for?

Hospice coverage is often provided by Medicare, Medicaid, and by many private insurance providers. At Hospice of Eastern Idaho, no one is turned away because of inability to pay. We can assist you in finding out whether the patient is eligible for any coverage. We appreciate it when anyone who does have the resources to pay for their care contributes as they can.

What are the costs associated with care outside the home?

Hospice Care IdahoPatients residing in a skilled nursing facility or assisted living facility can receive hospice care, but may still be responsible to the facility for room and board. Medicaid recipients remain eligible to have Medicaid pay for room and board charges, less any patient liability amount.

Patients residing in a skilled nursing facility for short term rehabilitative services (commonly referred to as the “100 day” benefit) under Medicare Part A cannot receive both benefits at the same time for the same diagnosis. Often, a patient will use the 100 day nursing home benefit, and then seek hospice care. Hospice can be involved when the patient is on their 100 Medicare days if the reason for hospice is different than the Medicare diagnosis. If financially able, they may forego the 100 day benefit, pay the facility room and board themselves, and enter hospice care.

What if I move to another city or state?

Hospice IdahoIf there is a hospice in the area you are moving to, we can transfer your records to the new hospice if you let us know ahead of time that you are moving. There is no loss of benefits and no need to start a new claim, providing you sign up with the new hospice within 2 days of leaving our care.

The Medicare hospice benefit requires you have a Medicare part A benefit (which is the program that pays for hospice care) which has been activated. If you are a non-working spouse, you may be eligible to draw Medicare under your working spouse’s number.

 

Hospice Idaho FallsThere are many diagnoses that are covered by the hospice benefit. Although many people think of hospice care in relation to terminal cancer, diseases such as heart failure, kidney failure, liver failure, stroke/CVA, dementia, Amyotrophic Lateral Sclerosis (ALS), Parkinson’s, AIDS/HIV, and even just the general effects of advanced age (Adult Failure to Thrive or debility), may qualify as hospice appropriate conditions, if the physician feels that the condition, assuming it runs its normal course, will result in death within six months.

Although the initial hospice benefit is for six months of coverage, this time can be extended in 60 day increments as long as the person continues to meet the medical criteria.