Eligibility and Enrollment

Learn more about hospice eligibility, benefit, coverage, and the focus of hospice care.

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Am I eligible for hospice?

• You are eligible for hospice if you have been diagnosed with a life-limiting illness and your doctor believes you are in the last stages of life, generally measured in weeks or months rather than years.*
  *See your Evidence of Coverage for details.
• You agree that your care will now focus on improving quality of life, relief of pain, and other symptoms, rather than a cure or life-prolonging treatments.
• You agree to receive care in a place of residence where hands-on care is provided by caregivers made up of family members, friends, or hired aides. Your medical care will be managed by Kaiser Permanente’s hospice care team.

More about eligibility

• Hospice care is given in defined benefit periods, which means a person receives care for a specific amount of time, then their health condition is reassessed to see if hospice is still needed. At Kaiser Permanente, a person can receive hospice care for two 90-day periods, followed by an unlimited number of 60-day periods.
• If your life expectancy improves or you decide to seek life-prolonging or curative treatments, your hospice care would be discontinued. You may also choose to discontinue hospice services for any reason at any time.
• Hospice care is generally paid for by Medicare, Medicaid, and private insurance or other health coverage. To find out more about eligibility rules under Medicare, you can view Medicare’s official guidelines. You can also see a summary on kp.org called “What is the Medicare Hospice Benefit?” Care may also be available to those unable to pay.
• A list of enrollment information, patient rights, and responsibilities is available here.

How do I sign up for hospice?

• Start by talking with your doctor and family to decide if hospice is the right choice for you. If you are eligible and decide hospice care is appropriate, your doctor will send a referral for you to the Hospice Services department, which will start an evaluation process.
• If you have more questions about Kaiser Permanente’s hospice benefit, please call Member Services at 800-464-4000.

What is needed for admission to hospice?

• You live within 15 miles or 30 minutes of Kaiser Permanente’s service area.
• You receive care ordered, arranged, or provided by a Kaiser Permanente doctor.
• Services required to treat your terminal condition can be safely and effectively provided in your place of residence as determined by a Kaiser Permanente hospice care team member.
• You have been diagnosed with a terminal illness, with life expectancy measured in weeks or months.
• You are not receiving curative medical treatments, except for comfort measures.
• You sign a statement documenting that you are choosing hospice instead of curative care.

* For most benefit plans, as a Kaiser Permanente member, you will not be charged for the services listed above when ordered, arranged, or provided by Kaiser Permanente as part of your hospice plan of care. Some plans may include a deductible for hospice services. For those plans where a deductible is applicable, the member is responsible for 100% of charges until the deductible is satisfied. Any deductibles will be billed to the member at rates provided to the member upon admission to hospice services. For specific information about your covered health plan benefits, please see your Evidence of Coverage.