Is there a cap on Hospice benefits under Medicare? -

Is there a cap on Hospice benefits under Medicare?


My hubby has been on hospice for 9 months. I was informed last week that the hospice benefit will terminate on Dec. 4. I was also advised that I could appeal the decision but I'm not planning to do that, I actually agree with them that he isn't really actively dying at this point. But they also advised that there is a lifetime CAP on hospice benefit; however, neither the social worker nor the nurse knew the details. I've looked on the site and various other websites and everything confirms what I've always I understood--that there are two 90-day periods followed by an UNLIMITED number of 60-day periods, as long as the patient is properly certified. The hospice social worker says if you "use up" the benefit, then you aren't able to get hospice coverage anymore. Anybody know the truth? Thanks!

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Thank you, BarbBrooklyn. Good info to have.
Helpful Answer (0)

Superstring, bear with me, as this is complicated stuff.

There is an aggregate cap on hospice organizations to prevent Medicare from paying them more for end of life care than Medicare would be paid if the patient was receiving conventional care, say in a hospital. Thus the cap has to do with the hospice organization, aggregated over ALL of their patients, not any individual patient.

In reading on both the CMS (Centers for Medicare and Medicaid) AARP and, they mention that there is a great deal of misinformation circulating about Hospice Caps. In your case, I would call the administrative office of your hospice organization on Monday and tell them about your conversation with their employees. They can set your mind at ease and correct the misinformation being spread.

Happy Thanksgiving!
Helpful Answer (2)

Superstring, check out Palliative Care. It's a "literal step" away from hospice, for people with chronic conditions but who aren't dying. It requires a script from a doctor and provides care similar to Hospice, but it differs in a few ways, one of which is that treatment for medical issues which wouldn't be treated through hospice are treated through PC.
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My hospice provider said they have never had Medicare cap a patient but they will disqualify for a period of time if they are not going downhill. My mom can will probably be released soon, but can go back on if she starts progressing downward later.
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