Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers pay for hospice care. If you find yourself entering hospice but don’t have any of these coverages, hospice can work with you and your family to ensure that the services you need are still provided.
The Medicare Hospice Benefit is covered under Medicare Part A (hospital insurance). According to the statistics provided by the National Hospice and Palliative Care Organization, more than 90% of hospices in the United States are certified by Medicare. Eighty percent of people who use hospice care are over the age of 65 and are entitled to the services offered by the Medicare Hospice Benefit, which covers all of the care related to the terminal illness (and related illness) that’s determined medically necessary by the hospice physician. If there is a medical condition that is not related to the terminal illness or related illness, the Medicare coverage you had before electing the hospice benefit will cover these illnesses.
In addition, most private health plans and Medicaid cover hospice services. Sometimes, patients’ health improves while under hospice care and if that is the case and your physician feels that you no longer need hospice care, you will no longer have hospice coverage but will return to the Medicare benefit you had before you entered hospice. However, should your illness return to the level deemed hospice eligible, you can return to it.
In order for Medicare to cover hospice services, the following criteria must be met:
- You must be eligible for Medicare Part A (Hospital Insurance).
- Your doctor and the hospice medical director certify that you have a life-limiting illness, and if the disease runs its normal course, death may be expected in six months or less.
- You sign a statement choosing hospice care instead of routine Medicare-covered benefits for your illness, including any health needs that aren’t related to your life-limiting illness or related illnesses.
- You receive care from a Medicare-approved hospice program.
All care that you receive for your terminal illness or related illnesses must be approved and provided by your hospice team. If you receive care for your terminal illness or related illnesses without hospice approval, you could be liable for the cost.
There are several hospice services that Medicare covers including doctor services, nursing care, home health aide and homemaker services and nearly pays for all of the costs. You will only have to pay part of the cost for outpatient drugs and inpatient respite care. Other services include:
- Social work services
- Therapy services (physical, occupational and speech therapy as determined medically necessary by hospice physician)
- Dietary counseling
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Drugs for symptom control and pain relief
- Short-term care in the hospital or skilled nursing facility for pain and symptom crisis management
- Inpatient respite for caregiver relief
- Short-term hourly care in the home for a pain and symptom crisis management
- Grief support to help you and your family during and after hospice services
It’s just as important to know what Medicare hospice benefit covers, as what it doesn’t cover.
You will receive comfort care to help manage symptoms related to your terminal illness but Medicare will not cover treatment that is intended to cure your illness or medications that are not directly related to your hospice illness. Comfort care includes medications for symptom control and pain relief, physical care, counseling, and other hospice services.
Hospice team members will consult with the hospice physician and will tell you and your family which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit. Hospice uses medicine, equipment, and supplies to make you as comfortable as possible. Under the hospice benefit, Medicare won’t pay for treatment where the goal is to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. You always have the right to stop at any time to seek curative care.
The hospice care provided by your team may include at-home visits but if you choose to receive care from another provider, it is not covered under the Medicare hospice benefit. If it’s deemed a necessity, you’ll need to pay for this out-of-pocket, or look into nursing homes as an option.
If a nursing home is chosen as the next step, Medicare hospice benefit won’t cover room and board, but Medicaid will if you’re eligible. If the nursing home works with hospice, then any hospice services received while you live there will be covered under the Medicare hospice benefit.
The palliative and hospice services covered under Medicare and Medicaid hospice benefits can seem daunting at first, but a little bit of research can go a long way and you can ask your local hospice for guidance when you need it.
Click here to learn more about who pays for hospice care.
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