Home Health vs Hospice Care - WLOX.com - The News for South Mississippi

Home Health vs Hospice Care

A Comparison of the Medicare Home Health Benefits and Hospice Benefits

Service

Medicare Home Health Benefit*

Medicare Hospice Benefit**

Nurse Covered for skilled care, if part time or intermittent Covered for skilled and supportive care
Physician Not covered under home care, but 80% of approved charge covered under Part B Attending physician 80% covered under Part B; consulting physician 100% covered under Hospice Benefit; hospice medical director consultations covered 100%
Social Work and Counseling Services Covered for patient Covered for patient and family (persons who play a significant role in the patient's life, including individuals who may or may not be legally related to the patient)
Pastoral Counseling and Chaplain Services Not covered Covered
Home Care Aide Covered, if part time or intermittent Covered, as specified in Hospice Plan of Care
Volunteers for Patient and Caregivers Not Covered Covered

Physical Therapy
Occupational Therapy
Speech Language Pathology

Covered, with some limitations on Occupational Therapy Covered, as specified in Hospice Plan of Care
Dietitian Not covered for individual patients Covered, as specified in Hospice Plan of Care
Respiratory Therapy Not covered for individual patients Covered, as specified in Hospice Plan of Care
Inpatient Care Not covered Covered, as specified in Hospice Plan of Care
Respite Care Not covered Covered, as specified in Hospice Plan of Care
Continuous Care May be covered where the need is finite and predictable Covered, as specified in Hospice Plan of Care, during a period of medical crisis
Services to Nursing Facility Residents Not covered Covered if patient is hospice-eligible and facility and hospice have a written agreement
24-hour On-call Services Not required, but frequently included Covered
Bereavement Counseling Not covered Covered
Medications Related to Primary Illness Not covered Covered
Durable Medical Equipment (DME) 80% approved amount covered under
Part B
100% covered, as specified in Hospice Plan of Care
Medical Supplies Covered 100% covered, as specified in Hospice Plan of Care
Service Periods and Certification Requirements

Unlimited services if qualifying and coverage criteria are met
Recertification every 60-62 days

The Medicare hospice benefit is divided into benefit periods:

  • an initial 90-day period;
  • a subsequent 90-day period; and
  • subsequent 60-day periods of indefinite duration

The beneficiary must be recertified as terminally ill at the beginning of each benefit period.

Homebound Required Not Required

* There are additional services that can be provided in the home but that are not included in the home health benefit. Medicare will pay for reasonable and necessary home health visits if the following requirements are met:
1. Patient needs skilled care.
2. Patient is homebound.
3. Care is authorized by physician.
4. Home health agency is Medicare certified.

** Medicare will pay for hospice care if the following requirements are met:
1.Terminal illness with a prognosis of 6 months or less, if illness progresses as expected, certified by  a physician.
2. Patient elects hospice benefit.
3. Hospice program is Medicare certified.

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