Tidewell Hospice has developed this web page to help you understand the Medicare Hospice Benefit. It is an excellent program, developed by the federal government to ease the financial burdens of individuals and families living with advanced illness. As a Medicare-certified program, Tidewell receives direct reimbursement from Medicare for the care provided to all Medicare-eligible patients who choose benefit.

Please take a few minutes to read through this Q&A. If you have questions, please use the "Keep in Touch" form at the bottom of the page or call the Tidewell office in your community.

17. Q - How do I know if I am eligible for hospice?

To be admitted to the hospice program, a person must meet the following criteria:

• Prognosis of six months or less
• Seeking palliative (comfort) care rather than curative care
• Reside in the area in which your hospice is licensed to provide service

17. Q - What is Hospice Medicare?

The Medicare Hospice Benefit is a specially legislated benefit for Medicare-eligible individuals enrolled in a certified hospice program. You are eligible for Hospice Medicare if you are eligible for Medicare Part A (the hospital insurance benefit).

17. Q - How do I know if I qualify for Hospice Medicare?

Hospice is covered for you under the Medicare Hospice Benefit if:

• You are eligible for Medicare Part A
• Your physician certifies that you have a prognosis of six months or less
• You elect the Medicare Hospice Benefit by a signed statement that you revoke your regular Medicare for the terminal illness only
• You receive care from a Medicare-certified hospice program.

17. Q - Will I lose my other Medicare benefits?

NO. Medicare will continue to provide health care coverage for problems not related to the terminal illness. For example, a patient is admitted to Tidewell with a brain tumor, and is also a diabetic. Hospice Medicare covers costs related to the brain tumor diagnosis and Medicare part A or B would continue to be applicable to the diabetes care.

17. Q - Does my Medicare HMO cover hospice care?

NO. Hospice is not a covered benefit under Medicare HMOs, however, original Medicare Part A provides hospice benefits.

17. Q - What is covered under Hospice Medicare?

All costs relative to the terminal illness and under the hospice plan of care are covered by Hospice Medicare. This includes:

• Nursing Care
• Drugs for pain relief and symptom control
• Social services counseling
• Home health aide and homemaker services
• Medical equipment
• Medical supplies
• Hospital stays for symptom relief
• Respite care
• Medical transportation
• Lab work
• Consulting physician services
• Physical and occupational therapy
• Speech therapy
• Dietary counseling
• Grief counseling for families
• Chaplains

17. Q - What is not covered?

The Medicare Hospice Benefit will not pay for:

• Curative treatments for the terminal illness
• Care from another hospice provider when not arranged by Tidewell
• Care for any medical problem not related to the terminal diagnosis
• Treatment of any kind not included in your personal Tidewell plan of care
• Hospitalization or emergency room treatment that is not in your Tidewell plan of care.

17. Q - What about my attending physician?

Your attending physician will continue to direct your care in coordination with the Tidewell interdisciplinary team. He or she may continue to bill Medicare part B as was his or her practice before you were admitted to Tidewell.

17. Q - Is Tidewell Hospice Medicare certified?

YES. Tidewell is licensed in the State of Florida and is Medicare and Medicaid certified. It is licensed to provide services in Sarasota, Manatee, Charlotte and DeSoto counties. Additionally, Tidewell has contracts with every acute care hospital in its service area, as well as most nursing homes.

17. Q - What will I have to pay for hospice care?

If you are eligible for Hospice Medicare, all services, equipment and medications related to you terminal diagnosis are covered. Tidewell bills directly to Medicare, so you should not receive a bill for services. You may, however, receive a statement of payment from Medicare, showing the amount they paid to Tidewell for your care.

The only out-of-pocket charge you might incur as a patient on Hospice Medicare is a room and board charge from Tidewell if you become a patient at one of our Hospice Houses.

17. Q - How does Medicare determine the amount to pay Tidewell?

In enacting the Medicare Hospice Benefit, the legistlature determined the most equitable way to reimburse for hospice services was through a per diem (daily) rate. Although this rate fluctuates from time to time and from region to region, it is approximately $100 per day. This is meant to cover all aspects of hospice care, whether the actual cost of service on any day is $1 to $5,000. This way, the government ensures that everyone has access to equal care, regardless of socioeconomic status or ability to pay. The rate and billing methodology is set by the federal government, not established by the individual hospice programs.

17. Q - Is there a time limit on the Medicare Hospice Benefit?

As long as your physician certifies that you are terminally ill and, in his or her best estimate, you have less than six months to live, you remain eligible for hospice care. Even if you live beyond the six-month period, you may continue to receive hospice care as long as your doctor recertifies that you meet the criteria.

The Medicare Hospice Benefit is divided into periods of care: two 90-day periods, followed by an unlimited number of 60-day periods. At the start of each period, your physician must certify that you meet the prognosis requirements to continue to meet eligibility standards and receive the benefit for that period. Payment is determined on days of care, not on a cost basis.

17. Q - What if I choose not to have hospice care any longer?

A patient always has the right to refuse hospice care, in which case the Medicare Hospice Benefit would be revoked and the patient would revert back to regular Medicare (Part A) for all health care. Also, a patient could be discharged from Tidewell if he or she improves and the physician can no longer certify that the prognosis is six months or less. Hospice and the Medicare Hospice Benefit will still be available at another time, as a patient meets the admission criteria.

17. Q - Can I change hospice care providers?

Hospice Medicare guidelines state that you can change hospice providers only once during each benefit period. Tidewell can facilitate transfers when a patient is moving to another city out of our service area, or when a patient plans an extended temporary visit out of the area.

17. Q - How can I learn more about Tidewell and Hospice Medicare?

To learn more about Tidewell services and the Medicare Hospice Benefit, please call and ask for the administrator at the Tidewell Hospice office in your community.