A Comparison of the Medicare Home Health Benefits and Hospice Benefits
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|
|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 |
|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
The Medicare hospice benefit is divided into benefit periods:
The beneficiary must be recertified as terminally ill at the beginning of each benefit period.
* 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.