Table of ContentsView AllTable of ContentsRoutine Home CareContinuous Home CareGeneral Inpatient CareRespite CareExclusionsChoosing a Provider
Table of ContentsView All
View All
Table of Contents
Routine Home Care
Continuous Home Care
General Inpatient Care
Respite Care
Exclusions
Choosing a Provider
The four levels ofhospice care, according to Medicare, are routine home care, continuous home care, general inpatient care, and respite care. A person qualified for hospice may experience one level of care or move between various levels depending on their specific needs. Every Medicare-certified hospice provider must offer all four levels of care.
If you haveMedicare Part AandPart B, you don’t pay anything for hospice other than a 5%coinsurancefee for respite care. You would also need to pay a share of the costs for any services unrelated to yourterminal diagnosis.
You would need routine home care if you are generally stable and your symptoms (such as pain, nausea, or vomiting) are adequately controlled.
Routine home care services can include:
Continuous home care is for times when you need a higher level of nursing care, and your symptoms are not being adequately controlled. As with routine home care, continuous home care is delivered either in your home, a skilled nursing facility, or an assisted living facility.
The purpose of continuous home care is to achievepalliation(relief of acute symptoms) until your condition is stable.
Qualifying SymptomsYou may need continuous home care if you have:Uncontrolled painUnrelenting nausea and vomitingAcute respiratory distressAgitation or “terminal restlessness”SeizuresCaregivers who are unable to provide care
Qualifying Symptoms
You may need continuous home care if you have:Uncontrolled painUnrelenting nausea and vomitingAcute respiratory distressAgitation or “terminal restlessness”SeizuresCaregivers who are unable to provide care
You may need continuous home care if you have:
Continuous home care may be provided only during a period of crisis. Once your condition is stabilized, you will be returned to routine home care.
If your condition cannot be managed at your home or in an assisted living facility, you may need to be stepped up to general inpatient care.
General inpatient (GIP) care is needed when pain and symptoms cannot be controlled in your home or an assisted living facility.
In such cases, you would need to be moved to a Medicare-certified hospice inpatient facility or a Medicare-certified hospital. If such facilities are not available, a Medicare-certified skilled nursing facility can be used.
The intention of GIP care is to achieve palliation until your symptoms are controlled and you are no longer in crisis.
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Respite care is provided when your family or caregiver needs time away from theintensity of caregiving. Respite care is provided at a local Medicare-approved facility, such as a hospital, hospice inpatient facility, or nursing home.
Medicare limits respite care to five consecutive days and charges a daily 5% coinsurance fee. You can use respite care more than once, but only on an occasional basis. If you stay beyond five days, you may be liable for room and board charges.
Exclusions of Medicare Coverage for Hospice Care
When you qualify for hospice care under Medicare, all direct costs of care related to your terminal diagnosis are covered.
These items are not covered:
Does Private Insurance Cover Hospice?Most private health insurance plans do cover hospice care because it is generally less costly than treatment in a hospital.If hospice benefits are included, most direct costs will be covered, but check for any exclusions or limitations to avoid unexpected out-of-pocket expenses.
Does Private Insurance Cover Hospice?
Most private health insurance plans do cover hospice care because it is generally less costly than treatment in a hospital.If hospice benefits are included, most direct costs will be covered, but check for any exclusions or limitations to avoid unexpected out-of-pocket expenses.
How to Choose a Hospice Provider
It is important to understand what Medicare covers and does not cover when choosing a hospice provider.
It is important, therefore, to ask the right questions when selecting a hospice provider, such as:
Summary
Medicare has four levels of hospice care: routine home care, continuous home care, general inpatient care, and respite care. You may need one or all levels of care depending on your unique needs and wishes.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Medicare.gov.Hospice levels of care.
Medicare.gov.Hospice care.
Centers for Medicare and Medicaid Services.Hospice.
Centers for Medicare and Medicaid Services.Medicare benefit policy manual. Chapter 9: Coverage of hospice services under hospital insurance.
Medicare.gov.More information about health care providers.
National Hospice and Palliative Care Organization.Continuous home care in the Medicare hospice benefit.
National Hospice and Palliative Care Organization.Hospice general inpatient (GIP) level of care frequently asked questions.
Hospice Foundation of America.Paying for hospice care.
Centers for Medicare and Medicaid Services.Suggested questions to ask when choosing a hospice.
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