What Hospice Does Not Cover

While the hospice benefit covers a variety of services, it does not cover all types of services. Two forces must be in play in order for an individual to qualify for hospice care. First, a physician must certify that the individual has a life-limiting condition and may have six (6) months or less to live. Second, the individual must choose to forego cure-oriented treatments and instead elect for a palliative approach to care. Because of these requirements, the Medicare hospice benefit will not pay for the following services:

Treatment intended to cure the terminal condition:

If you are considering getting treatment to “cure” your terminal condition, please speak with your doctor and hospice team. It is always within your rights to suspend hospice care and instead pursue a more curative approach.

Prescription medication intended to cure the terminal condition:

Hospice typically covers medications for pain management and symptom control.

Simultaneous care from another hospice company or medical care for the terminal condition that is not arranged by the hospice team:

We encourage you to discuss any plans to see a doctor with your hospice nurse. Some conditions may be unrelated to your terminal condition and can be treated outside of the hospice benefit. Please consult with your hospice nurse to determine whether this is the case. You may also see your general physician from time to time as needed. Dignity Hospice of Utah offers physician services that may make a house call if necessary.

Room and board:

Hospice care does not typically cover room and board at home, in an assisted living facility, or in a skilled nursing facility. However, hospice will pay for some short-term respite care (up to five days) in a skilled nursing facility. In addition, hospice will pay for short-term inpatient care in a skilled nursing facility to address uncontrolled symptoms as needed and desired.

Care in an emergency room, hospital, or inpatient facility:

Please contact your hospice team prior to seeking any of these services.

Ambulance or other forms of transportation:

Hospice will not cover these services unless they are previously arranged by your hospice team.

If you have any questions about what services hospice in Utah does or does not cover, please contact us today. We are happy to provide you with the information you need.