Hospice care aims to improve the quality of life of the terminally ill by focusing on comfort rather than curative treatment. Hospice care gives priority to the comfort of the terminally ill rather than the pursuit of a cure. In most cases, Medicare will pay for a dying senior’s medical expenses if they are enrolled in the programme and suffering from a terminal illness.
Medicare Requirements for Hospice Coverage
- Part A of Medicare must be in effect for the senior (hospital insurance).
- Hospice requires proof that the patient has a terminal illness and less than six months to live, which can be provided by the hospice medical director or the patient’s primary care physician.
- In order to receive Medicare coverage for palliative care instead of treatment for a terminal disease or related conditions, the senior (or their legal guardian) must make this choice and sign a statement to that effect.
- Only hospice care providers recognised by Medicare can provide services.
What Hospice Services Does Medicare Cover?
Hospice care is all-encompassing, meaning it helps both the patient and their loved ones. The following services, which may or may not be included in a patient’s plan of treatment, are partially paid by Medicare.
- Healthcare delivery from a physician.
- Aid in a nursing facility.
- Long-lasting medical tools (e.g., wheelchairs, walkers).
- Medicine and related items (e.g., bandages, catheters).
- Medications available by prescription only for the treatment of pain and other symptoms.
- Health and diet advice.
Assistance with housework and errands. - Therapy sessions for both physical and occupational needs.
- Help for people in need through social services.
- Counseling for the patient and their family after a loss.
- Treatment of pain and other symptoms in an inpatient setting for a limited time.
- Care provided in a hospital setting during a temporary stay.
- The hospice staff may also suggest alternative services that are covered by Medicare.
Hospice Respite Care for Family Caregivers
Physical and mental exhaustion are inevitable byproducts of caring for a terminally sick loved one. Medicare Part A helps cover in-patient respite care, which is one of the most helpful hospice services. So that the primary carer can get some rest, this programme pays for the terminally ill individual to stay in a hospice home, skilled nursing facility, or hospital that accepts Medicare. The duration of the inpatient respite stay can be up to five days, and the patient may be expected to make a small copayment toward the cost of their accommodation and board during this time. Respite care can be offered on an as-needed basis, but patients and their families may ask for it multiple times.
What Does Medicare Not Cover for Hospice Patients?
Medicare will not pay for the following if a beneficiary chooses hospice care and is eligible for it.
- Attempts to reverse the effects of a fatal disease by curative treatment.
Hospice care stops being paid for after an elderly person begins curative treatment for a terminal illness. Hospice care is voluntary, and patients can choose to stop receiving it at any time. - As long as they continue to complete all eligibility standards, they can restart treatment at any time.
Drugs available only by prescription, used to treat terminal conditions. - The Medicare hospice benefit only covers medications used to alleviate pain and other symptoms.
- Assistance from a hospice provider outside of the hospice medical team’s arrangement.
The patient’s choice of hospice medical team is responsible for providing or coordinating all treatment. Unless the senior makes a formal change to their designated Medicare-approved hospice provider, they will get the same level of care from their current hospice provider. - However, if the patient’s primary care physician or nurse practitioner has been designated as the hospice care supervisor, the patient is free to continue seeing them.
The price of lodging and meals. - Medicare does not pay for hospice patients’ housing costs, regardless of where they reside (at home, in a nursing home, an assisted living facility, or a hospice house). Only short-term hospitalisations and respite care stays qualify for free lodging.
Urgent treatment. - Medicare’s hospice coverage does not cover ambulance transportation, emergency department visits, or hospital stays unless they are organised by the hospice team or are unrelated to the patient’s terminal disease.
Your Hospice Care Costs With Medicare
Hospice care is typically covered completely or almost entirely by Medicare. You may have to pay a small copayment for the following supplies and services in some cases:
- Copayments for medications.
A patient’s maximum out-of-pocket expense for medications used in the treatment of pain and other symptoms will be $5. The hospice organisation will call the patient’s Medicare Part D prescription drug coverage to see if they will pay for the medication if it is not covered by the hospice benefit.
Reimbursement of 5% of the Medicare-approved amount for inpatient respite care. - Doctors and suppliers that agree to take assignments are paid a set fee (Medicare’s allowed expenses) for their services. As an illustration, if the approved cost of inpatient respite care is $100 per day, the patient will be liable for paying only $5 per day.
Even if a patient has a Medicare Advantage Plan (Part C) or a Medigap (Medicare Supplement Insurance) insurance, Original Medicare (Parts A and B) will pay for all of their care linked to a terminal disease. A senior on hospice who chooses to continue paying premiums in order to maintain Advantage Plan enrollment and access non-terminal medical benefits and services must do so. Policies that supplement Medicare cover items like medications and respite care for people receiving hospice treatment.
How Long Will Medicare Pay for Hospice Care?
Patients with less than six months to live are eligible for hospice care. However, determining an individual’s longevity is not a precise science. As a result, Medicare’s hospice benefit is split into two 90-day intervals followed by an unlimited number of 60-day periods (if needed).
As long as the hospice physician continues to attest that the patient has six months or fewer to live, the hospice treatment will continue to be reimbursed. Even though they are still considered terminally ill, some patients outlive their prognosis and continue to receive hospice care for significantly longer periods of time.
In order for a patient to get these services, they must first be certified as terminally ill by a doctor, and they must renew this certification at the beginning of each new benefit period. Prior to the start of their third benefit period (day 180 of hospice), they must have an in-person visit with a hospice physician to recertify their eligibility. These in-person recertification meetings are necessary prior to each successive 60-day benefit period and must take place no sooner than 30 days prior to the start of the new benefit period.
Keep in mind that the Centers for Medicare and Medicaid Services (CMS) has temporarily relaxed several requirements to permit the use of telehealth services in place of in-person contacts due of the ongoing COVID-19 outbreak. This entails follow-up visits to recertify hospice patients.
