Medicare offers a hospice benefit to beneficiaries who have terminal illnesses, allowing them to receive palliative, quality, end-of-life care.
What type of care is covered?
Medicare covers a good variety of hospice services, equipment, and medications, such as:
- Dietary/Nutrition counseling
- Doctor’s services
- Grief and loss counseling for the insured and their family
- Medical supplies and equipment
- Nursing care
- Physical therapy
- Prescription medications
- Respite care to provide the insured’s caregiver with rest for up to five days at a time
- Short term inpatient care for pain or symptom management, if necessary
Depending on a person’s unique situation, hospice care can vary, but the key aspect of hospice care is a shift from curative to comfort-oriented treatment. Once a person starts hospice, Medicare may no longer pay for appointments or medications that aim to treat the condition.
Who is eligible for hospice care?
Anyone enrolled in Medicare Part A is eligible for hospice care benefits. To receive the benefits, the insured must meet these criteria:
- A regular doctor and hospice doctor must verify the person is terminally ill and is likely to live for less than six months
- A person must accept they will now receive care to provide comfort rather than care that aims to cure or treat their illness
- The insured person signs a statement that indicates their desire to receive hospice care instead of other Medicare-covered treatments
A person is legally entitled to a hospice consultation to discuss hospice care with a hospice doctor or director through Medicare. Even if agreed to at the meeting, the person does not have to choose hospice care.
What happens if they live longer than six months?
In the case the person in hospice care lives longer than six months, a hospice provider should recertify that the person is still terminally ill. Ideally, hospice care should continue. A person has the right to stop hospice care if they want to, at any time.
What is the cost of hospice care?
Medicare will pay a person’s hospice care provider directly for their services. There is no deductible to be met when a person enters a hospice care program. There are, however, some costs that do apply. These include:
- Continuing to pay monthly premiums for Medicare Part A (if applicable) & B
- Paying a copayment of no more than $5 for prescription pain medications or other comfort management medications
- Pay a 5% coinsurance for the Medicare-approved amount for inpatient respite care
If the person’s condition needs hospital treatment while in hospice care, a hospice organization should make the arrangements. This is crucial since the hospice provider will directly pay the hospital. If the person has a Medicare Supplement, it may help cover these out-of-pocket expenses. For specifics on Medicare Supplement coverage, a person should contact their plan administrator.
What is Medicare hospice care?
Hospice care provides support and cares for those reaching the end of their lives and their family. It changes the focus of treatment focus from active treatment and the resolution of conditions to providing support and care to help the person live out their life on their terms. Hospice care is not usually received for a medical condition until they are nearing the last six months of their life. Hospice care is usually received in the person’s home, but it can vary. Some examples of hospice services are:
- End of life counseling
- Medical equipment to support comfort and mobility like hospital beds, walkers, etc.
- Medications to ensure the person is as comfortable as possible
- Physical care to help with activities like bathing, eating, and getting dressed
- Other supplies or services to make the person more comfortable
Many chronic medical conditions like cancer, COPD, congestive heart failure, or dementia may benefit from hospice care.
Where can a person receive hospice care?
When it was first added to Medicare, hospice care was originally limited to the person’s home. In 1989, the eligibility for hospice care extended to those living in nursing facilities. This meant that people who live in a nursing home or assisted living home would receive the same hospice benefits as those who live in their own homes. Sometimes, a person may start their hospice care at home but move to a nursing facility due to a change in their needs. Medicare will still cover hospice in these instances.
However, it is important to note that Medicare does not cover room and board when receiving hospice care in another facility like a nursing home. So, if the person does require transfer to a facility, they are responsible for the cost of room and board.
Does it affect standard cover?
When a person enters hospice, the hospice provider becomes the primary provider for funding their services. If the person does require coverage or care not related to their terminal illness, this is still covered by Medicare or Medicare Advantage. If the person requires further care due to their terminal illness, such as an emergency room or doctor’s visits, this much be arranged with the hospice provider. It is the hospice organization’s job to go over all this fully with the individual, helping them fully understand what is and is not part of their hospice care.
How to get Medicare hospice coverage?
Securing hospice care through Medicare depends on the type of plan a person has. Regardless, the person must choose a Medicare-approved hospice. To find Medicare-approved hospices, a person should call Medicare (1.800.633.4227) and ask for their state’s hospice organization’s number. They can also be searched on Medicare.gov. On the other hand, those with Medicare Advantage plans must select a specific provider in their plan’s network. Contact the plan’s administrator to get a list of local providers. As long as a person can still pay their premiums, they can keep a Medicare Advantage policy while in hospice.
Hospice care and reduce the hospital stays and trips to the emergency room that a person may otherwise experience during the end of their life. Medicare will cover this benefit and provide as much comfort as needed to keep those with terminal illnesses comfortable in their last days. Once hospice begins, however, coverage for treatment no longer applies. If someone is in the final stages of a terminal illness, they may discuss the possibility of hospice care with their provider to ensure their comfort.