All You Need to Know About Medicare and Medicaid for Hospice & Home Health

Medicare and Medicaid provide health insurance for numerous Americans, but often people don’t understand how coverage works for our core programs of hospice care and home health care. Here are some of the most frequently asked questions we get regarding Medicare and Medicaid for both.

What is Medicare?

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities and people with End-Stage Renal Disease. It has three parts: Part A, which covers inpatient hospital stays, skilled nursing facility care, hospice care and some home health care; Part B, which covers certain doctors’ services, outpatient care, medical supplies and preventive services; and Part D, which covers prescription drugs.

What is Medicaid?

Medicaid is a federal health insurance program for low-income children, their caretakers, pregnant women and certain people with disabilities. 

HOSPICE CARE

How does someone qualify for hospice care under Medicare?

To qualify for hospice care under Medicare, a doctor has to certify that someone has less than six months to live if their disease goes at its expected rate.

What if somebody survives longer than six months in hospice care?

Since there is no way of knowing how long someone may live on hospice, benefits continue until the patient has passed away.

How does someone qualify for hospice care under Medicaid?

The hospice qualifiers for Medicaid are the same as for Medicare.

What does hospice care cost for someone on Medicare or Medicaid?

Hospice doesn’t cost the patient anything.

What do Medicare and Medicaid cover regarding hospice care?

Medicare covers the cost of hospice, which can include multidisciplinary nurses, social workers, chaplains and home health aides among other related professionals. It also covers the cost of medication for pain and symptom management in addition to equipment they may need such as a hospital bed, wheelchair or dressing supplies.

HOME HEALTH CARE

How does someone qualify for home health care under Medicare?

To qualify for home health under Medicare, a patient has to get a provider referral, which can be a physician, nurse practitioner or physician assistant. This necessitates a “face-to-face encounter” with the provider during which the provider decides a patient meets “homebound status.” This encounter can oftentimes be virtual.

How does someone qualify for home health care under Medicaid?

The home health qualifiers for Medicaid are the same as for Medicare.

What does home health care cost for someone on Medicare or Medicaid?

Home health does not cost the patient anything under Medicare or Medicaid, though there are sometimes visit limits for home health patients on Medicaid.

What do Medicare and Medicaid cover regarding home health care?

Medicare and Medicaid cover home health services across the board, minus occupational and speech therapies in Missouri (they are covered in Kansas, however). At VNA Kansas City, we offer strictly home health services focused on clinical care. We do not offer private duty caregiving services such as meal preparation, cleaning and other household chores. As previously stated, all of these services require orders from a physician.

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