Review stage Before signing hospice paperwork First week of hospice care Already enrolled and reviewing care Considering a hospice provider change Considering stopping hospice care
Coverage context Original Medicare Medicare Advantage plan Medicaid or dual coverage Private, VA, retiree, or other coverage Not sure
Care setting Home Assisted living or memory care Nursing home Hospital Inpatient hospice setting
Attending doctor choice Not decided yet Chosen but not confirmed Chosen and confirmed No outside attending doctor chosen
Non-covered item addendum Not requested Requested and waiting Received but confusing Not needed right now
Provider status Choosing a provider Provider already chosen Concerns with current provider Changing provider now
Main concern today What hospice covers or excludes Outside care or possible surprise bill Medicines, supplies, or equipment Facility room and board Quality, safety, or missed care concern
Caregiver or helper role Family helper nearby Long-distance family helper Facility staff involved No clear helper yet
Hospice records status Scattered notes or verbal summaries Missing copies of paperwork Private folder is ready
Next contact to prepare for Hospice intake or nurse Medicare, plan, or billing call Facility or discharge planner BFCC-QIO or advocacy contact Family meeting
Use this before signing or changing Medicare hospice paperwork.
Do not enter diagnoses, Medicare numbers, Social Security numbers, claim numbers, medication details, addresses, account numbers, or private medical facts into this planner.
This planner is educational and organizational only. It is not medical, legal, insurance, benefits, financial, tax, or hospice-placement advice. Confirm personal care, coverage, provider, facility, and revocation decisions with qualified clinicians, Medicare, the plan, hospice providers, and appropriate professionals.
Official references:
Medicare hospice care coverage ,
CMS model hospice election statement ,
Medicare Care Compare hospice search ,
CMS hospice overview ,
Eldercare Locator .
