Medicare’s Hospice Benefit

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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Having “the talk” with your parents

How many of us know what our parents’ wishes are for healthcare and long-term care as they age and approach the end of their lives? The only real way to know is to ask them – but how many of us have done that?

It can seem like an awkward and unappealing conversation to begin. No one likes to think about a time when they may be too sick or too old to care for themselves, or that their parents might reach that point. However, those situations can arise suddenly and without warning.  Only by talking with them about this now will you be prepared if a healthcare crisis occurs. And parents – if your kids don’t want to bring this up, then you need to sit them down and tell them your wishes.

You may think you know what care your parents want, but chances are you will be a little – maybe a lot – surprised about what they tell you their wishes are – mom may want to stay at home instead of going to a facility, or dad may no longer want to be resuscitated. If you KNOW, then you will be in a position to honor their actual wishes.

Also, talking about this as a family and knowing their wishes can avoid tearing a family apart during a crisis, when sis wants to do this, brother wants to do that, and you are the tie-breaker, or worse. All too often, these disputes can end up in court, and every member of the family pays a significant financial and emotional cost. 

In addition to you and your parents talking candidly about their preferences, assure that they each have written healthcare directives, which include living wills, which will make clear what their end-of-life decisions are, but will also make clear whom they want to make decisions about their medical care when they are unable.

And while you’re at it, get your own house in order – if you have adult children, have this discussion about your own wishes with them, and put your own advance directives in place!    

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Wellness Visit or Physical for Medicare Recipients

For those of us on Medicare, which generally includes those over the age of 65 or disabled persons, Medicare offers a little-known free benefit, an annual wellness visit, as part of the preventative care services it provides. However, confusing a wellness visit with a physical examination could be very costly. 

As part of the Affordable Care Act, Medicare beneficiaries receive a free annual wellness visit. At this visit, your doctor, nurse practitioner, or physician assistant will generally do the following: 

  • Ask you to fill out a health risk assessment questionnaire 
  • Update your medical history and current prescriptions
  • Measure your height, weight, blood pressure and body mass index
  • Provide personalized health advice 
  • Create a screening schedule for the next 5 to 10 years
  • Screen for cognitive issues

You do not have to pay anything, not even a deductible, for this visit. You may also receive other free preventative services, such as a flu shot. 

The confusion arises when a Medicare patient requests an “annual physical” instead of an “annual wellness visit.” During a physical, a doctor may do other tests that are outside of an annual wellness visit, such as check vital signs, perform lung or abdominal exams, test your reflexes, or order urine and blood samples. These services are not offered for free, and Medicare patients may have to pay co-pays and deductibles when they receive a physical. Kaiser Health News recently related the story of a Medicare recipient who had what she assumed was a free physical only to get a $400 bill from her doctor’s office. 

Adding to the confusion is that when you first enroll, Medicare covers a “welcome to Medicare” visit with your doctor. To avoid co-pays and deductibles, you need to schedule it within the first 12 months of enrolling in Medicare Part B. The visit covers the same things as the annual wellness visit, but it also covers screenings and flu shots, a vision test, review of risk for depression, the option of creating advance directives, and a written plan, letting you know which screenings, shots, and other preventative services you should get. 

To avoid receiving a bill for an annual visit, when you contact your doctor’s office to schedule the appointment, be sure to request an “annual wellness visit” instead of asking for a “physical.” The difference in wording can save you hundreds of dollars. 

Of course, those who have supplemental insurance in addition to Medicare (Medigap or Medicare Advantage) may have a different experience, including having to pay nothing for a physical examination; if you want a physical instead of just a wellness visit, you should check with your supplemental insurance carrier or your doctor’s billing office to determine whether there will be a charge based on the additional insurance coverage that you have.

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