Insight

The Basics of Hospice Care

The Basics of Hospice Care

Anthony J. Enea

Anthony J. Enea

May 1, 2019 12:02 PM

The decision as to whether one should begin receiving hospice benefits is often an emotionally draining and difficult decision, not only for the person needing hospice care, but also for their family. It is sadly the realization that one’s life may soon be ending and that the attempts of curing the person’s illness have been unsuccessful.

Hospice is a program of care for people who are terminally ill and have been diagnosed with a life expectancy of six months or less. The focus of the hospice care shifts from curing the individual to palliative care (keeping the person comfortable). The palliative care component is both for the terminally ill person and his or her family. The physical, emotional, and spiritual care needs of the patient and family are now the focus.

In most instances hospice care is provided at home, however, if it cannot be provided at home there are in-patient facilities that specifically provide hospice care. For example, Calvary Hospital in the Bronx, N.Y. and Rosary Hill Home in Hawthorne, N.Y. are in-patient facilities dedicated to hospice care.

Medicare will cover hospice care at the aforestated types of in-patient hospice facilities. However, if one decides to receive hospice care at a nursing home or another non-hospice facility it may be necessary that the patient apply for and obtain Medicaid or pay privately for room and board at the non-hospice facility.

Once the patient has been certified for hospice by his or her doctors, is willing to accept palliative care and forego any attempts to cure the illness, and executes a statement choosing hospice care, the hospice care will commence.

Unlike long-term nursing home care, the vast majority of hospice care benefits are paid for by Medicare. Medicare hospice benefits cover the care for the terminal illness and any related conditions. Once one is eligible for hospice care, Medicare hospice benefits should cover everything one needs related to the terminal illness (except treatment), even if one remains in a Medicare Advantage Plan or other Medicare health plan.

Once the hospice benefits have commenced one can still get covered services that are not related to one’s terminal illness: original Medicare will cover the services for any health problems that are not part of the terminal illness and related conditions, subject to the patient being responsible for paying all deductibles and co-insurance amounts.

The hospice provider selected by the patient for the in-home care will coordinate a care plan for the terminally ill patient with the patient and his or her family. The care team will include a hospice nurse and a doctor who is on call 24 hours per day, seven days per week. The patient can also include his or her regular doctor, a nurse practitioner or a physician’s assistant as part of the medical team.

Although hospice care is generally associated with terminally ill cancer patients, hospice care is provided for all terminal illnesses where the patients’ life expectancy is six months or less.

Once hospice benefits have commenced Medicare will no longer cover the following:

  1. Treatments intended to cure the terminal illness and related conditions;
  2. Prescription drugs (except for symptom control or pain management);
  3. Care from a provider that was not arranged by the hospice medical team;
  4. Generally, room and board are not covered, unless it is a hospice facility or if the hospice team determines the patient needs short term in-patient respite care services (when the usual caregiver needs rest inpatient respite care can be provided in a Medicare approved facility, hospital or nursing home).

Once on hospice care, the patient will continue to pay the Medicare monthly Part A premium and Part B premiums, a copayment of up to five dollars per prescription for outpatient prescription drugs for pain and symptoms management and five percent of the Medicare approved amount for inpatient respite care.

As can be seen from the above, obtaining hospice care at home or at an in-patient facility requires that a number of different factors be both present and satisfied before the Medicare approved hospice benefits will be available. Virtually all services need to be first coordinated and approved by the hospice care provider selected.

Related Articles

Pandemics and Planning: Lessons Learned


by Anthony J. Enea

It's important to be prepared for life-threatening emergencies, such as the COVID-19 pandemic. Here are six basic estate planning documents and advanced directives that everyone should have in order to deal with any potential health crisis.

Estate Planning for COVID-19

As Fla. Pushes to Repeal Controversial 'Free Kill' Law, DeSantis Signals Veto


by Bryan Driscoll

The fight to transform state accountability standards may be in trouble

free kill law hed

In the News: Texas 2019


by Best Lawyers

A roundup of relevant news from lawyers listed in Texas.

Legal News Roundup Texas

Health Care Prime


by Jonathan K. Henderson, Robert A. Guy, Jr., Andrew Kinworthy and Kevin McDonell

How will M&A shape the American health industry going forward? By adhering to the Amazon model.

Health Care on Demand

The Power of Two


by Kerrin B. Slattery and Dale Van Demark

More health care companies than ever see the value of robust partnerships in a constantly changing industry.

Health Care and the Private Sector

Insurance Coverage to Protect the Health Care Industry from the Increasing Risks Associated with the Internet of Things


by Meghan Magruder and Amy Dehnel

While this connectivity can provide great benefits to patients and physicians, the security issues inherent in these devices are critical.

Insurance for Health Care Industry

Ellen G. Makofsky, 2018 "Lawyer of the Year" for Elder Law


by Nicole Ortiz

Ellen G. Makofsky of Makofsky and Associates was named 2018 "Lawyer of the Year" in Long Island for Elder Law.

Ellen G. Makofsky LOTY

Anthony J. Enea, 2018 "Lawyer of the Year" for Elder Law


by Nicole Ortiz

Anthony J. Enea of Enea, Scanlan & Sirignano, LLP was named 2018 "Lawyer of the Year" in White Plains for Elder Law.

Anthony J. Enea LOTY

The New Era for Health Care Services in the United States


by Bobby Guy & Brook Bailey

The future of Obamacare is unclear, and what U.S. health care will look like when the political fuss is over is an inquiry punctuated by a very large question mark.

Health Care Services

Public Health Reform: What does the future look like for patients?


by Vanessa Mellis

Increased government stewardship and a stronger user orientation are two of the key elements shaping this process.

Public Health Reform

Protect Your Pets: Westchester Elder Law Attorney Anthony Enea Explains How to Provide for Pets in an Estate Plan


by Anthony J. Enea

Along with pet ownership comes the responsibility of ensuring your companion animal's care and well-being - even if that extends beyond your lifetime.

Elder Law - Pets Estate Plan

Trending Articles

Introducing the 2026 Best Lawyers Awards in Australia, Japan, New Zealand and Singapore


by Jennifer Verta

This year’s awards reflect the strength of the Best Lawyers network and its role in elevating legal talent worldwide.

2026 Best Lawyers Awards in Australia, Japan, New Zealand and Singapore

Revealing the 2026 Best Lawyers Awards in Germany, France, Switzerland and Austria


by Jamilla Tabbara

These honors underscore the reach of the Best Lawyers network and its focus on top legal talent.

map of Germany, France, Switzerland and Austria

Effective Communication: A Conversation with Jefferson Fisher


by Jamilla Tabbara

The power of effective communication beyond the law.

 Image of Jefferson Fisher and Phillip Greer engaged in a conversation about effective communication

The 2025 Legal Outlook Survey Results Are In


by Jennifer Verta

Discover what Best Lawyers honorees see ahead for the legal industry.

Person standing at a crossroads with multiple intersecting paths and a signpost.

The Best Lawyers Network: Global Recognition with Long-term Value


by Jamilla Tabbara

Learn how Best Lawyers' peer-review process helps recognized lawyers attract more clients and referral opportunities.

Lawyers networking

Jefferson Fisher: The Secrets to Influential Legal Marketing


by Jennifer Verta

How lawyers can apply Jefferson Fisher’s communication and marketing strategies to build trust, attract clients and grow their practice.

Portrait of Jefferson Fisher a legal marketing expert

Is Your Law Firm’s Website Driving Clients Away?


by Jamilla Tabbara

Identify key website issues that may be affecting client engagement and retention.

Phone displaying 'This site cannot be reached' message

A Guide to Workers' Compensation Law for 2025 and Beyond


by Bryan Driscoll

A woman with a laptop screen reflected in her glasses

Medical Malpractice Reform Trends in Texas, Utah, Georgia and SC


by Bryan Driscoll

A fresh wave of medical malpractice reform is reshaping the law.

Medical Malpractice Reform Trends hed

Why Jack Dorsey and Elon Musk Want to 'Delete All IP Law'


by Bryan Driscoll

This Isn’t Just a Debate Over How to Pay Creators. It’s a Direct Challenge to Legal Infrastructure.

Elon Musk and Jack Dorsey standing together Infront of the X logo

Best Lawyers Launches CMO Advisory Board


by Jamilla Tabbara

Strategic counsel from legal marketing’s most experienced voices.

Group photo of Best Lawyers CMO Advisory Board members

Changes in California Employment Law for 2025


by Laurie Villanueva

What employers need to know to ensure compliance in the coming year and beyond

A pair of hands holding a checklist featuring a generic profile picture and the state of California

Common Law Firm Landing Page Problems to Address


by Jamilla Tabbara

Identify key issues on law firm landing pages to improve client engagement and conversion.

Laptop showing law firm landing page analytics

New Employment Law Recognizes Extraordinary Stress Is Everyday Reality for NY Lawyers


by Bryan Driscoll

A stressed woman has her head resting on her hands above a laptop

Best Lawyers Introduces Smithy AI


by Jamilla Tabbara

Transforming legal content creation for attorneys and firms.

Start using Smithy AI, a content tool by Best Lawyers

How to Create High-Converting Landing Pages for Your Law Firm


by Jamilla Tabbara

Learn how to create high-converting law firm landing pages that drive client engagement and lead generation.

Laptop screen displaying website tools to improve client conversion rates