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Southern Utah Home Health & Hospice
Starting care · coverage · day one

How hospice starts — and what it costs

The short version: for most families on Medicare, hospice costs nothing out of pocket, a doctor’s order is all that is required, and care can begin the same day. Here is the whole process in plain language, with no fine print hidden anywhere.

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How to start

Four steps, start to finish

Most of this is our work, not yours. You can stop at any point, and nothing is signed until you have coverage confirmed in writing.

  1. Someone makes the call

    A patient, a family member, a physician, a hospital case manager, or a facility nurse. No physician order is needed to ask questions — only to admit.

  2. We visit and evaluate — free

    Usually within a day, often the same day. A nurse assesses the situation, we explain exactly what hospice would look like for this person, and we answer everything.

  3. Two physicians certify eligibility

    Medicare requires certification that the prognosis is six months or less if the illness runs its usual course — from the attending physician and our medical director, Dr. Karen Radley. We coordinate both; you do not chase signatures.

  4. You sign, and care begins

    You elect the hospice benefit in writing and choose which conditions the plan covers. Medications, equipment, and the first nursing visit follow immediately — often that same day, including evenings and weekends.

What to have handy (nice, not necessary): the Medicare or insurance card, a current medication list, the names and numbers of treating physicians, and any advance directive, living will, or POLST form. If you don’t have these, we will help you get them.

What it costs

Medicare, Medicaid, and private insurance

Hospice is one of the most complete benefits in American health care — and one of the least understood. Here is what is included and what falls outside it.

Included — no cost to most families

Covered by the hospice benefit

  • Nursing visits, including a registered nurse (RN) on call 24 hours a day
  • Certified nursing assistant (CNA) visits for bathing, grooming, and personal care
  • Physician oversight by our medical director, alongside the patient’s own doctor
  • Medications for the hospice diagnosis and for symptom relief
  • Medical equipment — hospital bed, oxygen, wheelchair, walker, commode
  • Medical supplies — wound care, gloves, incontinence supplies
  • Medical social work, benefits help, and advance-directive assistance
  • Chaplain and spiritual support, for any faith or none
  • Comfort therapies including massage, plus trained volunteers
  • Short-term inpatient care and respite care when needed
  • Bereavement support for the family for 13 months after a death
Outside the benefit

Not covered by hospice

  • Treatment intended to cure the hospice diagnosis — you may always revoke hospice and return to curative treatment.
  • Room and board if the patient lives in an assisted living or skilled nursing facility. Hospice covers the care; the facility still bills for the room. (Utah Medicaid may cover room and board for those who qualify.)
  • Care for conditions unrelated to the hospice diagnosis — still billed to Medicare or your insurer in the normal way.
  • Care from another provider we did not arrange — call us first, and we will arrange it so it is covered.
  • Emergency room visits and ambulance transport we did not arrange. Call our nurse first; nine times out of ten we can handle it at home.

Some plans apply a small copay — commonly up to $5 per prescription for symptom medications, and 5% of the Medicare-approved amount for inpatient respite. Many families pay neither. We will tell you your exact numbers before you sign.

Medicare

Hospice is covered under Part A for anyone enrolled who meets the criteria. There is no hospice deductible. If you have a Medicare Advantage plan, the hospice benefit is still administered through Original Medicare — your plan choice does not limit your choice of hospice agency.

Utah Medicaid

Covers hospice on terms similar to Medicare, and for those who qualify can also cover room and board in a nursing facility — which Medicare hospice does not. Our social worker helps families sort out dual eligibility.

Private insurance & VA

Most commercial plans include a hospice benefit, and coverage details vary by plan — we verify yours and tell you the numbers before admission. Veterans Affairs (VA) benefits may also apply; tell us if your loved one served.

Coverage rules can change, and every plan has its own details. Nothing on this page replaces the written verification we give you before you sign, and we never guess at your numbers.

Levels of care

Four levels, and you can move between them

Medicare defines four levels of hospice care. Most people are at the first one nearly all of the time — but the others exist for exactly the moments families fear most.

Routine home care

The everyday level: scheduled nurse and CNA visits wherever home is, with a nurse reachable at any hour.

Continuous home care

Extended nursing hours in the home during a crisis, to get a symptom under control without going to the hospital.

General inpatient care

Short-term care in a contracted facility when symptoms cannot be managed at home. Temporary by design — the goal is always to get back home.

Respite care

Up to five consecutive days in a facility so the family caregiver can sleep, travel, or simply recover. Asking for it is not a failure.

What happens day one

The first 24 to 48 hours

The beginning matters. Here is what we do immediately, so that nobody spends the first night wondering who to call.

  • Admission visit and full assessment with a comfort plan written for this specific person, not a template.
  • Comfort medications delivered, usually as a small kit kept in the home so there is never a midnight pharmacy run.
  • Equipment set up — bed, oxygen, commode, wheelchair, mattress overlay, whatever the house actually needs.
  • One phone number on the fridge that reaches a nurse at any hour.
  • Introductions to your nurse and CNA, and how to reach the social worker and chaplain.
  • Family teaching — how to give a comfort medication, how to turn someone safely, what is normal, and which changes warrant a call.
  • Coordination with the physician and, if the patient is in a facility, with the facility’s nursing staff.

Coming home from the hospital?

Call us before discharge paperwork is finished. We coordinate directly with the case manager so the bed, the oxygen, and the medications are waiting when your loved one arrives — one trip home, not two.

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Admissions questions

The paperwork questions families ask

Do we need a physician’s order to be admitted?

Yes — Medicare requires certification of the prognosis by the attending physician and the hospice medical director. But you do not need an order to call us, ask questions, or have us come out and evaluate. We obtain the certifications ourselves.

How long does admission take?

Usually a few hours from decision to first visit, and often the same day you call — including evenings and weekends. The longest delays are almost always waiting on records from somewhere else, and we chase those ourselves.

What are benefit periods and recertification?

Medicare structures hospice as two 90-day benefit periods followed by unlimited 60-day periods. At each renewal a physician recertifies that the person still meets criteria, which for later periods includes a face-to-face visit. This is our administrative work, not a countdown clock on your loved one, and it does not interrupt care.

Can we stop hospice if we change our minds?

Yes, at any time and for any reason — it is called revoking the benefit. You return to standard Medicare coverage for that condition immediately and may elect hospice again later. Nobody has to justify the decision to us.

Does the patient have to give up their own doctor?

No. The attending physician stays in charge of care and works with our medical director. If someone would rather have our medical director take the lead, that is also allowed — it is the patient’s choice.

What if the family cannot afford anything at all?

Tell us. Care is never withheld over ability to pay, and our social worker will work through Medicaid eligibility, VA benefits, and community resources with you. Start with the phone call — the money conversation is not the barrier people fear it is.

Want your exact numbers?

Call and we will verify your coverage and tell you, in writing, what you would pay before anything is signed.

435-635-1001