The Medicare hospice benefit provides coverage for participants, assisting them and their families in coping with the difficult experience of a terminal illness. Patients and families dealing with end of life are experiencing many emotions, questions and worries. With the Medicare benefit covering hospice care, it allows for comfort care, helping minimize some of these worries, including medication costs and pain management.
Medicare provides coverage for hospice care costs to patients in their home, in a hospice facility, hospital, nursing home, or other facility. If you or a loved one have been diagnosed with a life-limiting illness with a prognosis of six months or less to live, there is help available with Medicare hospice coverage.
Requirements for Medicare Hospice Coverage
Patients can receive hospice comfort care such as prescriptions for pain, assistance with daily living and support for the family when they meet the following medicare hospice eligibility criteria:
The patient must have:
- Medicare Part A (hospital insurance)
- A physician’s diagnosis and life expectancy of six months or less
- The patient must elect palliative care rather than Medicare-covered benefits intended to treat an illness by signing a statement
- Hospice care must be provided by an approved Medicare hospice provider
Patients that elect Medicare hospice care and live longer than six months can receive unlimited additional 60-day periods as long as their physician certifies that the life expectancy is still six months or less. Patients are also not locked into the decision to begin hospice care. They can revoke the Medicare hospice benefit and reelect it again later.
Patients may be admitted to hospice whether or not they have completed advance directives, although preparing financial, medical and legal documents is highly recommended when facing a life limiting illness. It is not required for patients to elect a “do not resuscitate” order to qualify for hospice. Studies done suggest that patients who begin hospice care earlier in their diagnosis typically live longer than those who do not.
What’s Covered Under Medicare and Hospice Coverage
Medicare hospice coverage includes care that is necessary and reasonable to ease the course of a terminal illness. The Medicare Hospice Benefit covers:
- Nursing care
- Physician and nurse practitioner services
- Medical supplies and appliances
- Durable medical equipment (wheelchairs, hospital bed, etc.)
- Prescriptions for pain relief and symptom management
- Short term inpatient and respite care
- Home health aide services
- Social work services and counseling
- Nutritional and dietary counseling
- Spiritual care
- Grief and loss bereavement services for the family
Services which are aimed at making the patient more comfortable and improving their quality of life are considered to be appropriate. Medicare will also cover the initial consultation with a hospice physician to consult with the patient and may include a pain assessment and counseling on end of life care options.
Medicare and Hospice Respite Care
Respite care is short term hospice care provided to patients on a temporary basis of up to five days at a time in order to relieve caregivers. Caring for a terminally ill loved one is emotionally and physically taxing. There are times when caregivers need a break or may be away and unable to provide the care needed. Respite care is covered under Medicare comfort care and is available for caregivers to utilize for assistance in caring for a loved one.
What’s Not Covered Under Medicare Hospice Care
When patients choose Medicare hospice coverage, they decide to no longer receive curative treatments for a terminal illness and hospice coverage usually covers everything that is needed. Medicare will no longer cover other things once hospice begins such as:
- Curative treatments intended to cure the terminal illness or related conditions. Speak with your physician if you want to continue curative treatments as you have the right to stop hospice care at any time.
- Prescription drugs for curative treatment (as opposed to prescription drugs for managing comfort)
- Room and board. Medicare covers hospice care costs but not room and board at a facility such as a nursing home or long term care facility. If the hospice care team determines that respite care or a short-term inpatient stay is needed, Medicare will cover your stay in the facility. A small co-pay may be required for respite care.
- Care from any hospice provider that is not part of the hospice medical team chosen. Hospice care must be from the provider you chose, you can still see the physician that you elect as your Attending Physician. This may be a primary care doctor, oncologist, cardiologist, etc. when receiving hospice care.
- Care received as hospital outpatient such as from an ambulance, an emergency room or hospital inpatient unless arranged by your hospice provider or is unrelated to your terminal illness.
Be sure to contact your Angels Grace Hospice & Palliative Care team before receiving any of these services to avoid incurring charges not covered by Medicare.
What You Pay for Hospice with Medicare
Most patients will pay very little to nothing at all when choosing Medicare and hospice. Everything that a patient needs related to comfort hospice care is covered under Medicare hospice coverage (Parts A and B) even if they are enrolled in a Medicare Advantage Plan (Part C) or if they have a Medicare Supplemental Insurance policy.
Patients will need to continue paying premiums for an Advantage Plan if they wish to make use of services and benefits not related to their terminal illness. Medigap policies may provide additional coverage for services like respite care or prescription drugs while receiving hospice care. You can learn more about Medicare end of life care and how hospice works at Medicare.gov.
Medicare Comfort Care
Angels Grace Hospice & Palliative Care provides comforting hospice And palliative care services As covered under Medicare. They provide this care using a team of compassionate and skilled nurses and doctors experienced in end-of-life care. Many people wait longer than they should to inquire about and start receiving hospice or palliative care. Quality hospice care is more about living than dying, it is a philosophy of care to help patients and family caregivers focus on comfort and quality of life.
Angels Grace Hospice & Palliative Care provides comforting hospice care, bringing peace and dignity to people with a life-limiting illness. If you or a loved one are facing a serious or life-limiting illness, speak with your physician about Medicare covered hospice providers. Contact us to learn more about Medicare hospice coverage.