Hospice or Home Health?
A Comparison of Medicare Home Health Benefits and Hospice Benefits*
|SERVICE||HOME HEALTH BENEFIT¹||HOSPICE BENEFIT²|
|Skilled Nursing||Covered for skilled care, if part-time or intermittent, or daily for 21 days or less.||Covered for skilled and supportive care|
|Physician||Not covered under home care, but 80% of approved charge covered under Part B||Attending non-hospice affiliated physician 80% covered under part B; consulting hospice physician 100% covered|
|Medical Social Work||Covered for patient||Covered for patient and family|
|Chaplain Services||Not covered||Covered for patient and family|
|Homemaker/Home Health Aide||Covered if part-time or intermittent, must provide "hands on personal care." 28-35 /wk w/SN & HHA||Covered, no hourly restriction.|
|Volunteers For Patient & Caregivers||Not included||Included|
|Medications Related to Primary Illness||Not included||Covered|
|Durable Medical Equipment||80% of approved amount covered||100% covered|
|Respite Care||Not covered||Covered for up to 5 consecutive days|
|24-Hour On-Call Nurse||Not required||Included|
|Bereavement Care||Not included||Included|
|Inpatient Care||Not covered under home care, but covered under hospital benefit||Covered|
|Medical Supplies||Medical supplies covered||Medical and personal supplies covered|
|Dietician||Not covered for individual patients||Covered|
|Physical Therapy Occupational Therapy Speech-Language Pathology||Covered with some limitations on occupational therapy||Covered|
|Services to Nursing Facility Residents||Not covered||Room & Board not covered|
|Skilled Continuous Care||Not Covered||Covered, during periods of medical crisis|
¹There are additional services that can be provided in the home, but are not included in the home health benefit. Medicare will pay for reasonable and necessary home health visits if all the following requirements are met: 1. Patient needs skilled care; 2. Patient is homebound; 3. Care is authorized by physician; and 4. Home Health agency is Medicare-certified. (42 CFR §409.42)
²Medicare will pay for hospice care if all the following requirements are met: 1. Prognosis that life expectancy is 6 months or less. (42 CFR §418.3) 2. Terminal illness is certified by physician; 3. Patient elects hospice benefit; 4. Care is specified in the hospice plan of care; and 5. Hospice program is Medicare-certified. (42 CFR §418.21, 418.22, 418.24).
* THIS IS NOT A GUARANTEE OF BENEFITS.