Does Medicare cover hospice care?
This article was updated on: 12/21/2017
If you’re considering Medicare hospice care for yourself or a loved one, you may be comforted to know that the Medicare hospice benefit is available to help eligible terminally ill beneficiaries and their families with end-of-life issues such as pain management and assistance with caregiving.
How Medicare hospice care works
Unlike traditional care that seeks to cure the disease, hospice care focuses on maximizing the quality of life by providing comfort and support services. Medicare hospice care involves a core interdisciplinary team of professionals and caregivers who provide medical, psychological, and spiritual support tailored to the terminally ill person’s needs and wishes as well as support for the family. Your Medicare hospice team can include physicians, nurses, social workers, home care aides, counselors and volunteers, as long it’s a Medicare-approved hospice organization that provides them. A Medicare hospice doctor is part of your medical team. Your regular doctor or nurse practitioner can also be part of this team. Furthermore, a Medicare hospice nurse and doctor are typically on call 24 hours a day, 7 days a week to give you and your family support and care when you need it.
Medicare hospice services are often based in the home, enabling families to be together sharing their final days in comfort and dignity, according to the Hospice Association of America (HAA). When home-care services are not an option, inpatient care is available from a Medicare-approved hospital, skilled nursing facility, or Medicare hospice inpatient facility. Your Medicare hospice doctor can also arrange for inpatient care for temporary circumstances. For example, occasionally you may be able to get inpatient respite care for up to five days in a Medicare-approved facility if a family member who is your usual caregiver needs a rest. Your Medicare hospice doctor can arrange this for you.
When to consider Medicare hospice care
Medicare hospice care is an option to consider at the time your doctor renders a terminal prognosis, regardless of your diagnosis or physical condition. You have the right to determine when you feel Medicare hospice care is appropriate (instead of continuing to treat your health condition) and which Medicare-approved program suits your needs. Before you enter a Medicare hospice care program, however, a Medicare-assigned doctor must certify that you’ve been diagnosed with a terminal illness and have a life expectancy of six months or less if the illness runs its normal course. When trying to make this difficult decision, you may want to discuss it with your doctor, who can explain the probable implications of pursuing traditional curative care or Medicare hospice care.
Covered Medicare hospice services
You can receive Medicare hospice benefits under Original Medicare Part A when you meet these conditions:
- You’re eligible for Original Medicare Part A (hospital insurance).
- Your doctor and the hospice medical director certify that you’re terminally ill and have six months or less to live if your illness runs its normal course. (You can be re-certified for Medicare hospice care by your hospice doctor as needed or you can withdraw from the Medicare hospice program and return to your former Medicare coverage if your condition goes into remission.)
- You sign a statement choosing Medicare hospice care instead of other Medicare-covered benefits to treat your terminal illness. (Medicare may still pay for covered benefits for any health problems that aren’t related to your terminal illness.)
- You get Medicare hospice care from a Medicare-approved hospice program.
Medicare hospice services that are typically covered when they’re needed to care for your terminal illness and related condition(s) include:
- Physician services
- Nursing care
- Medical supplies (such as catheters) and equipment (such as walkers)
- Prescription drugs for symptom control and pain relief (you may have to pay a $5 copayment)
- Nutritional counseling; social worker services; and grief counseling for you and your family
- Medicare hospice aide and homemaker services
- Short-term inpatient care (for pain and symptom management)
- Short-term respite care (you may need to pay a small copayment)
- Other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your Medicare hospice team
All Medicare-covered services you get while in Medicare hospice care are generally covered under Original Medicare, even Medicare-covered services for conditions unrelated to your terminal illness. This is true even if you’re enrolled in a Medicare Advantage plan or other Medicare health plan. A Medicare Advantage plan is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Medicare Part A and Medicare Part B benefits. However, Medicare hospice care is covered directly by Original Medicare when you have a Medicare Advantage plan. For more information, you may want to read the publication, “Your Medicare Coverage: Hospice & Respite Care.”
If you would like to learn more about your Medicare hospice coverage and options, I would be pleased to help you.
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This website and its contents are for informational purposes only. Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.