The Medicare Hospice Benefit, as well as most private insurers, will pay for a patient’s hospice treatment. If the patient does not have adequate coverage through Medicaid, Medicare, or any type of private insurance, hospice providers will work directly with each individual and their loved ones to make sure the necessary care will be given.
How to Utilize The Medicare Hospice Benefit
The Medicare Hospice Benefit offering coverage to individuals is under Part A of Medicare. This is the portion of Medicare that provides hospital insurance. There are a full range of medical and support services available for those receiving Medicare who choose hospice care. Hospice providers also offer a variety of services to support the families of the patients through the Medicare Hospice Benefit.
In the United States more than 90 percent of all hospices have been certified by Medicare. Of all the people using hospice services, 80 percent are over the age of 65 and eligible to receive the care offered through the Medicare Hospice Benefit. All the services that are related to the terminal illness are covered by this benefit if deemed necessary by hospice care providers. Any medical condition that is not related to the individual’s terminal illness will be covered by the Medicare coverage that was in place before the hospice benefit was used. In almost all instances private insurance and Medicaid will cover the expenses of hospice care.<
Ending Hospice Care
If an individual’s health begins to improve significantly or and illness begins remission the hospice doctor may decide that hospice care is no longer needed. In these circumstances the patient would be discharged from hospice and go back to the previous care and Medicare coverage that was in place before the hospice benefit had been used.
The patient also has the right to stop hospice for any reason, at any time. Again, the patient would return to the previous type of coverage under Medicare that was in place before entering hospice care. If the patient’s health should change,, the patient can again go back to hospice care at any time.
How is Eligibility Determined for Medicare Hospice Benefits?
An individual must be eligible for the Medicare Part A, Hospital Insurance, and have both a physician and the medical director of a hospice certify that the patient has a life-limiting disease in order to qualify for the Medicare Hospice Benefit. It must also be certified that if this illness takes its usual course death will likely occur within six months. Finally, the patient must sign a statement to choose hospice services instead of regular benefits covered by Medicare. It should be noted that Medicare will still pay for health expenses that were covered benefits but are not related to the life limiting disease.
What Exactly Will Medicare Cover?
There are several core services regarding hospice that hospices are required to provide and that Medicare will cover, no matter what type of insurance an individual has. The following is a list of hospice services that Medicare covers. In a large majority of cases, Medicare will pay nearly all of these costs.
- Physician care
- Nursing services
- Medication for pain relief and control of symptoms
- Equipment such as walkers and wheelchairs
- Supplies such as catheters and bandages
- Short term hospital stays that include pain and symptom care
- Occupational and physical therapies
- Speech therapies
- Health aides and homemaking services in the home
- Nutritional counseling
- Social services
- Grief counseling for the patient and family members
- A portion of the cost of inpatient respite care and outpatient medications.
The Medicare Hospice Benefit does not cover any type of treatment meant to cure a patient’s illness. A patient will be entitled to comfort care to assist in the management of symptoms related to the disease. The type of comfort care covered would include drugs for pain, relief, and control of symptoms, physical care, certain types of counseling, and related hospice needs.
Prescriptions Related to Curative Treatments
Prescriptions that are not specifically related to a patient’s life-limiting illness that necessitated hospice care are not covered with the Medicare Hospice Benefit. Typically, the members of the hospice team will discuss with the hospice doctor what medications are needed and inform the patient and family which will be covered under this benefit.
What about the same treatment from another provider that is received from hospice?
All services that a patient gets related to their life-limiting illness must be provided by the hospice team. A patient can’t receive the same kind of treatment from another provider unless the patient changes to another hospice provider.
Room and Board at a Nursing Facility
The Medicare Hospice Benefit doesn’t cover room and board at nursing facilities. However, Medicare covered hospice services can be administered wherever that individual lives, even if it is in a nursing facility. If a patient is eligible for Medicaid, the Medicaid benefits may pay for room and board.
A hospice team may provide hospice care in the patient’s home that is visit based or intermittent. An individual will receive visits from the hospice team according to both the individual’s and the family’s needs. The Medicare Hospice Benefit does not cover hourly services. If this type of care is needed the patient will be required to pay out of pocket for these services or look into another type of care such as a nursing facility which provides around the clock care.