Medicare’s Hospice Benefit

Hospice-1793998_640 (1)All of us would like, at the end of our lives, to go peacefully to sleep, without any suffering or hardship. Unfortunately, many people at the end of their lives are faced with a terminal illness, which is a process, and can last weeks or months.

In such cases, Medicare provides a hospice which benefit covers any care that is reasonable and necessary for easing the course of a terminal illness.

It is one of Medicare's most comprehensive benefits and can be extremely helpful to both the terminally ill individual and his or her family, but it is little understood and underutilized. Understanding what is offered ahead of time may help Medicare beneficiaries and their families make the difficult decision to choose hospice if the time comes.

The focus of hospice is palliative care, which means helping people who are terminally ill and their families maintain their quality of life. Palliative care addresses physical, intellectual, emotional, social, and spiritual needs, while also supporting the terminally ill individual's independence, access to information, and ability to make choices about health care. 

To qualify for Medicare's hospice benefit, a beneficiary patient must be entitled to Medicare Part A, and a doctor must certify that the patient has a life expectancy of six months or less. If the patient lives longer than six months, the doctor can continue to certify the patient for hospice care indefinitely. However, the patient must also agree to give up any treatment to cure his or her illness and elect to receive only palliative care.

This can seem overwhelming, but patients can also change their minds at any time. It's possible to revoke the benefit and reelect it later, and to do this as often as needed.

Medicare will cover any care that is reasonable and necessary for easing the course of a terminal illness. Hospice nurses and doctors are on-call 24 hours a day, 7 days a week, to give beneficiaries support and care when needed. Services are usually provided in the home. The Medicare hospice benefit provides for:

  • Physician and nurse practitioner services
  • Nursing care
  • Medical appliances and supplies
  • Drugs for symptom management and pain relief 
  • Short-term inpatient and respite care 
  • Homemaker and home health aide services 
  • Counseling 
  • Social work service 
  • Spiritual care 
  • Volunteer participation 
  • Bereavement services 

Services are considered appropriate if they are aimed at improving the patient's life and making him or her more comfortable.

Because the patient is electing palliative care over treatment, there are things the hospice benefit will not cover:

  • Room and board. If the patient is in a nursing home, hospice will not pay for room and board costs. This is important to understand; Medicare will pay for the hospice services, but not the cost of the facility. However, if the hospice team determines that the patient needs short-term inpatient care or respite care services, Medicare will cover a stay in a facility.
  • Treatment to cure the patient's illness. 
  • Prescription drugs other than for symptom control or pain relief. 
  • Care from a provider that wasn't set up by the hospice team, although the patient can choose to have his or her regular doctor be the attending medical professional. 
  • Care from a hospital, either inpatient or outpatient, or ambulance transportation unless it arranged by the hospice team. The patient can use regular Medicare to pay for any treatment not related to the patient's terminal illness. 

Medicare's Hospice Benefit booklet can be found at www.medicare.gov/Pubs/pdf/02154-Medicare-Hospice-Benefits.PDF. This is well worth reviewing and even printing out.

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