Enrolling in Medicare Hospice From the First Call to the First Visit: The Paperwork in Order
Hospice coverage starts with a physician's certification and a signed election, and the paperwork decides which bills Medicare pays and which the family still owes.
Hospice enrollment is mostly paperwork, and the papers decide what Medicare pays for and what lands on the family. This page walks the enrollment in order so you know what to ask at each step. Whether a person qualifies, and what the medical care should be, are decisions for the physician and the hospice team. This page does not make those calls. (Medicare.gov)
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
Step 1: Confirm the certification
Hospice coverage requires a physician or nurse practitioner to certify eligibility in the patient's medical record. Ask the hospice who will provide the certification and when, and get the name of the person who will sign. The clinical facts behind it belong to the medical team.
Step 2: Learn the benefit periods
Medicare's hospice benefit runs in periods. Ask the hospice to explain how many days each period covers and how the periods are counted, and to tell you when a new period starts. Ask in writing what happens if the person leaves hospice and later returns. (Medicare.gov)
Step 3: Read the election statement
Signing the election means the person chooses hospice for the terminal illness and gives up some Medicare coverage for care related to that illness. Other care can still be billed under Original Medicare. Ask the hospice to mark on the form which care is covered by the hospice, which care still runs through Medicare, and which costs fall to the family. Do not sign until those lines are answered.
Step 4: Check the equipment and supply route
Hospice covers equipment and supplies tied to the terminal diagnosis, usually through the hospice's own vendors. Ask who delivers, who sets up, who picks up, and what happens to items that are no longer needed. Get the return route in writing, because a delivered item without a return route becomes a family cost later.
Step 5: Get the contact tree
Hospice teams provide a visit schedule and a after-hours line. Ask for the name of the nurse coordinator, the number for the team after business hours, and the number to call when a visit is missed. Write the three numbers on the front of the packet.
Step 6: Keep the revocation route
The person can revoke hospice, and the election paperwork and the hospice will explain how. Ask for the revocation form now, so the family knows where it is before the question comes up.
Stop lines
Advance directives, a health care power of attorney, guardianship, and who makes decisions if the person cannot are legal questions. Take them to a lawyer through the Missouri Bar referral service. Medical choices stay with the physician and the family. For Medicare billing questions that remain after the hospice explains its papers, a SHIP counselor is the next call, and the Local Help With Paying for Care page lists the St. Louis contacts.