Metropolitan Hospice ~ A Community of Caring

Q. Will the Benefit pay for hospice care in a place other than a personal residence?

Sometimes a patient does not or cannot reside in a private home. The Benefit reimburses for hospice services that are delivered in freestanding hospice facilities, hospitals, and nursing homes and other long-term care facilities. However, the Benefit does not cover expenses for room and board. In some instances, Medicaid may cover these expenses for eligible patients. For benefits available under Medicaid, consult the Georgia Medicaid office.

Yes. If there is a brief, acute episode that requires additional care to manage pain or acute medical symptoms, nursing care may be covered on a continuous basis to maintain the patient at home. Skilled nursing or home health aide services, or a combination of both may be covered on a 24-hour basis during periods of crisis, but care during these periods must be predominantly nursing care.

If a hospice inpatient admission is necessary for the patient, the Metropolitan Hospice team will arrange for the patient's stay in a Medicare-approved facility such as a freestanding hospice facility, hospital, nursing home, or other long-term care facility.

Caregivers, who are family or friends responsible for the care of the hospice patient, may, on occasion, need a break, or respite, from daily care giving. To provide relief to the caregiver, respite care may be provided in a Medicare-approved facility such as a freestanding hospice facility, hospital, nursing home or other long-term care facility for up to five days at a time.

Q.What Services are not Covered under Hospice Care?

Services for the terminal diagnosis that are not called for in the hospice care plan or arranged for by the hospice program.

Services for conditions unrelated to the terminal illness.

Care that patients receive under the Hospice Benefit for their terminal illness must be from a Medicare-approved hospice program, such as Metropolitan Hospice.

How is Metropolitan Hospice Effective in Alleviating Some of the Out-of-Pocket Costs to the Patient?

Medicare, Medicaid, and private insurers pay the hospice directly for the patient's hospice care. Patients may be responsible for five percent (up to $5.00) of each medication prescribed for pain relief and symptom management. The hospice patient may also be responsible for 5 percent of Medicare payment amount for inpatient respite care. However, at Metropolitan Hospice, we continually alleviate this expense through private donations and our resources.

Is a Patient's Coverage Forfeited if Hospice Care is Chosen?

Not at all. A patient retains full Medicare coverage for any health care needs unrelated to the terminal diagnosis, even if the patient elects Metropolitan Hospice. The patient must continue to pay the applicable deductible and coinsurance amounts under the standard Medicare Plan.

How Long Can a Patient Receive Hospice Care?

For as long as the physician continues to re-certify the terminal illness, patients can receive hospice care. Two 90-day periods of care are followed by an unlimited number of 60-day periods as long as the patient remains eligible. Hospice care is provided once a physician determines that if a disease runs its natural course, his patient will have a life expectancy of six months or less.

What if a Patient is Enrolled in a Medicare Managed Care (HMO) Plan?

A hospice-eligible patient who is enrolled in a managed care plan may choose any Medicare-certified hospice provider. Authorization from the managed care plan is not required.

Can a Patient Change His or Her Hospice Provider?

Yes. A hospice patient has the right to change hospice providers at any point, as long as the newly chosen hospice program is Medicare-approved..

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Is there any relief for caregivers?

Does the Benefit cover general inpatient care that may be needed as a result of a crisis or an acute episode that cannot be handled in a patient's primary residence?

Does the Benefit cover continuous care (a special level of hospice care) at home?

Q1. Will the Benefit pay for hospice care in a place other than a personal
residence?
Q2. Does the Benefit cover continues care at home?
Q3. Does the Benefit cover general inpatient care?
Q4. Is there any relief for caregivers?
Q5. What services are not covered under hospice care?
Q6. How are we effective in alleviating some costs to the patient?
Q7. Is a patient's coverage forfeited if hospice care is chosen?
Q8. How long can a patient receive hospice care?
Q9. What if a patient is enrolled in a Medicare managed care plan?
Q10. Can a patient change his or her hospice provider?