Understanding Key Differences Between The Different Types Of Medicare Plans
There are a lot of details that you should not overlook when evaluating your Medicare plans. Again, we refer you to theofficial Medicare government website for the most recent information.
Free counseling and personalized help with navigating the complexities of Medicare is also available through your State Health Insurance Assistance Program . You can find a SHIP counseling location using their online locator.
What Is Hospice Care
Increasingly, people are choosing hospice care at the end of life. Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.
At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease’s progress.
Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person’s illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course.
It’s important for a patient to discuss hospice care options with their doctor. Sometimes, people don’t begin hospice care soon enough to take full advantage of the help it offers. Perhaps they wait too long to begin hospice and they are too close to death. Or, some people are not eligible for hospice care soon enough to receive its full benefit. Starting hospice early may be able to provide months of meaningful care and quality time with loved ones.
What Are The Parts Of Medicare
The different parts of Medicare help cover specific services:
- Medicare Part A : Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health.
- Medicare Part B : Part B covers certain doctors services, outpatient care, medical supplies, and preventive services.
- Medicare Part D : Helps cover the cost of prescription drugs .
With Medicare, you have options in how you get your coverage. There are two main ways:
- Original Medicare Original Medicare pays for much, but not all, of the cost for covered healthcare services and supplies.
- Medicare Advantage Medicare Advantage is an all in one alternative to Original Medicare. These bundled plans include Part A, Part B, and usually Part D.
Learn more about Medicare coverage at Medicare.gov.
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The Rulesforhospiceand Medicare In New Jersey
The governmenthealth-insurance program can help pay for comfort-care toward the end of life.
If you or a loved one are on Medicare, you probably know it covers many medical services. Depending on the type of Medicare plan youve chosen, the program can help pay for your doctor visits, hospitalizations, prescription drugs and more.
But what if you are terminally ill, and you no longer want aggressive treatment? How will you maintain your comfort and dignity and perhaps even remain at home for your last weeks and months? You may also have questions when it comes to paying for hospice care.
Thats where hospice comes in. Hospice is a special kind of care for people near the end of life, which focuses on enhancing comfort and quality of life, rather than attempting to cure the person.
But what happens when it comes to dying for hospice care? The big question becomes: Is hospice care covered by Medicare?
For many people, the answer is yes. Medicare has certain rules about who qualifies for coverage of hospice care, which are explained below.
Your Hospice Care Costs With Medicare
Most Medicare beneficiaries pay little to nothing for hospice care. In some situations, the following small out-of-pocket copays may be necessary for certain items and services:
- Prescription co-pays.A patient will pay no more than $5 for each prescription drug and other similar products they need for pain relief and symptom control. If a specific medication is not covered by the hospice benefit, the hospice provider will contact the patients Part D prescription drug plan to inquire about covering it.
- Five percent of the Medicare-approved cost for inpatient respite care.Medicare negotiates fixed rates with doctors and suppliers who accept assignment. For example, if the approved cost is $100 per day for inpatient respite care, then the patient will only be responsible for paying $5 per day.
Original Medicare will cover everything a patient needs related to their terminal illness, even if they are enrolled in a Medicare Advantage Plan or have a Medigap policy. If a senior on hospice wishes to remain enrolled in their Advantage Plan and make use of medical benefits and services unrelated to their terminal illness, then they will need to continue paying their premiums. Medigap policies typically provide additional coverage for things like prescription drugs and respite care for patients while they are receiving hospice care.
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What Is Inpatient Hospice Care
In hospice care, sometimes you or your loved one may experience symptoms that are severe and unrelieved. A hospice team will do their best to manage these symptoms in your home environment. These symptoms include pain, shortness of breath, nausea and vomiting, and severe anxiety. The hospice team will work with you, your family, and your physician to make any necessary changes to you or your loved ones medications or other treatments to relieve these symptoms.
However, sometimes these symptoms do not respond to the regular medications available in the home environment. When these symptoms do not improve over 24 to 48 hours, then the hospice nurse may decide to transfer you or your loved one to an inpatient center so symptoms can be managed more quickly.
What Is Included In Palliative Care
During hospice care, the following services and items may be rendered as a form of palliative care.
- Doctor and nursing care services
- Walkers wheelchairs, catheters and other equipment designed for comfort or convenience
- Prescription drugs used for symptom or pain relief
- Grief counseling
- Respite care
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Am I Eligible For Coverage
You become eligible for Medicare-covered hospice care when you meet all of the following requirements:
- Your regular doctor and hospice doctor certify that you are terminally ill and have 6 months or less to live.
- You choose palliative care for comfort instead of treatments to cure your illness or prolong your life.
- You sign a form stating your choice for hospice care instead of treatment-related care.
When you receive hospice care, your comfort is the most important priority. Many different hospice services are available, based on your end-of-life needs. These may include:
- doctor and nursing services
- physical, occupational, and speech therapy
- grief counseling for you and your family members
- short-term inpatient or respite care
While Medicare generally covers almost everything related to hospice care at no cost, it doesnt cover living expenses while at home or at another living facility.
What Are Palliative Care And Hospice Care
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Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. Its important for older adults to plan ahead and let their caregivers, doctors, or family members know your end-of-life preferences in advance. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to health care providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.
If the person is no longer able to make health care decisions for themselves, a caregiver or family member may have to make those decisions. Caregivers have several factors to consider when choosing end-of-life care, including the older person’s desire to pursue life-extending treatments, how long he or she has left to live, and the preferred setting for care.
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Does Medicare Cover Hospice Care
Hospice care focuses on care for terminally ill patients, tending to their emotional and spiritual needs at the end of their life. A big goal associated with hospice care is comfort and the quality of the patients life the goal is to minimize suffering and pain.
When a patient has six months or less to live, their health is rapidly declining, or they are ready to live more comfortably than it may be time for hospice care. Your hospice care plan can consist of doctors services, drugs for pain management, homemaker services, physical therapy, and even grief counseling for your family, to name a few.
Find A Medicare Advantage Plan Today
Medicare Advantage plans are privately sold alternatives to Original Medicare. By law, they must cover the same benefits as Original Medicare.
If you receive hospice care, you will still receive it from Medicare Part A.
Some Medicare Advantage plans offer benefits that Original Medicare doesn’t offer, such as prescription drug coverage and caregiver support services.
Learn more about the other additional benefits that may be covered by Medicare Advantage plans where you live.
Find Medicare Advantage plans that cover palliative care
Or call to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.
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What Can Oasis Hospice Care Do For The Health Of Your Loved One
Hospice doctor care is an extra layer of treatment for your loved one at home or in a care center, provided in collaboration with your family and their doctors. When a patient enters hospice care, they are surrounded by a team of people who can help start them with their physical, mental, and spiritual needs. The treatment for the patients terminal disease, as well as all medical equipment and supplies related to this condition, are given at no cost to the patient or his or her family.
Nurses and aides are available from Oasis Hospice & Palliative Care to help with health and personal care needs. Our social workers will assist the family in locating additional services and preparing for the end of life. Chaplains provide spiritual guidance and grief support. Volunteers step in and offer companionship visits to your loved one while allowing family members to relax. For those who need additional assistance, bereavement counselors are available. Contact us to find out how to start this care right away for your loved one.
Planning For Final Expenses
Many of us spend years planning for our life in retirement. Planning for our deaths, however, isnt quite as much fun.
The simple fact is that Medicare coverage ends, well, when your life does. And Social Securitys death benefit is a mere $255. According to the National Funeral Directors Association, the national median cost of a funeral with viewing and burial in 2019 was $7,640.1
Relying on retirement assets left to your estate to pay the bill is 1 option. Purchasing a final expenses insurance policy offers another.
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When Does Medicare Cover Hospice Care: Quick Screen For Hospice Coverage
Medicare claims for hospice care are suitable for coverage, and appeal if they are denied, if they meet the following criteria:
- A hospice physician must certify that the beneficiary is terminally ill. This means that in the physicians judgment the individual has 6 months or less to live if the illness runs its normal course.
- The beneficiary or his/her representative must elect the Medicare hospice benefit by signing and filing a hospice benefit election form with the hospice of choice.
- The beneficiarys attending physician and the hospice physician must certify the beneficiary for the initial period. For subsequent periods the hospice physician recertifies the beneficiary.
- After having been certified by a hospice physician, the beneficiary may elect the hospice benefit for two 90 day periods and an unlimited number of subsequent 60 day periods.
- Before the start of each 60-day period, the beneficiary must have a face-to-face encounter with a hospice physician or nurse practitioner to determine continued eligibility.
- All hospice care and services furnished to patients and their families must follow an individualized written plan of care established by the hospice interdisciplinary group in collaboration with the attending physician , the patient or representative, and the primary caregiver, in accordance with the patients needs if any of them so desire.
- The care must be provided by, or under arrangements with, a Medicare certified hospice.
Medicare Advantage Plans And Palliative Care
Medicare Advantage, also known as Medicare Part C, offers you a way to receive your care options through a private insurance plan. These insurance plans cover the same things that Original Medicare covers, with no exceptions. This means that any palliative care option that is covered under Original Medicare will also be covered by Medicare Advantage.
There are, however, a few notable things about Part C coverage. Your Part C plan may have different out-of-pocket costs than Original Medicare, and this can apply to your palliative care. For example, you may have a different deductible, copayment, or coinsurance than what you would pay under Original Medicare. In most cases, your premium for Part C will be lower, but your out-of-pocket costs will be slightly higher. However, this is far from uniform.
Another difference is that Medicare Advantage may cover long-term care options that arent covered by Original Medicare. While Part C plans must cover at least what Original Medicare covers, they can also cover more. This means that Part C plans may offer you even more options for palliative care. However, like with most things related to Part C, this can vary. Make sure you examine the details of your plan.
Lastly, your Part C plan may cover prescription drugs, which are not covered by Original Medicare. In this case, your plan will function straightforwardly just make sure the drugs you need are covered by your plan.
Read Also: When Can You Apply For Part B Medicare
Does Medicare Advantage Cover Dementia
Advantage plans must offer the same benefits as Medicare. That means you can expect your Medicare Advantage plan to cover an annual dementia screening as well as medical costs.
Medicare Advantage plans come with deductibles, copays, and doctor networks, so your costs may be different than if you had Medicare.
Advantage plans could benefit dementia patients:
- A Medicare Special Needs Plan for dementia is tailored to the needs of dementia patients.
- Some Medicare Advantage plans may offer in-home long-term care benefits beyond whats available under traditional Medicare. These benefits might include adult daycare, nutrition services, or in-home caregiving.
Advantage plans vary by location. Plans geared toward dementia and long-term care may or may not be available in your area.
What Kinds Of Care Does Hospice Include
Generally, hospice care includes services which are reasonable and necessary for the comfort and management of a terminal illness. These services may include:
- Physician services.
- Medical supplies, including drugs and biologicals and medical appliances.
- Counseling, including dietary counseling, counseling about care of the terminally ill patient, and bereavement counseling.
- Short term inpatient care for respite care, pain control, and symptom management.
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Hospital And Inpatient Setting
Medicare Part A will provide coverage for palliative care costs if the service is given in a hospital, skilled nursing facility, or an inpatient setting. Medicare Part A will cover the following:
- Inpatient hospital stays along with the treatment and medications that the patient requires
- A short period of stay at a skilled nursing facility along with medications, rehab care, and daily care
- Limited home healthcare which includes part-time skilled nursing or home healthcare and rehabilitation services
- Hospice care that the patient needs at the end of his/her life
At Home Or Outpatient Setting
Medicare Part B will cover the cost of palliative care if you receive it outside of hospice care. Medicare Part B will cover the following:
- Visits to the healthcare provider for diagnosis and treatment of the illness
- Durable Medical Equipment
- Mental health counseling and emotional support for the patient as well as his/her family
- Outpatient rehabilitation care including speech, physical, and/or occupational therapy
Medicare Advantage plans also provides coverage for palliative care as they cover everything Original Medicare covers. However, out-of-pocket costs will vary depending on the plan provided by the plan providers.
There are private insurance companies that partner with Medicare Part C to offer Special Needs Plans . SNPs provide additional medical services as well as more versatile services for patients diagnosed with a life-threatening illness.
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Choosing A Doctor: Does Insurance Cover Palliative Care
Most private health insurance plans and health maintenance organizations cover palliative care services, although some treatments and medicines may not be covered under individual plans.
Medicare Part B and Medicaid also pay for some palliative care, depending on the treatment. Medicare generally doesnt separate palliative care from the rest of your covered services, so your palliative care provider will be paid like any doctor.
Here are four questions you should ask a potential provider if youre considering palliative care.
Will my loved ones be involved? One of the main tenets of palliative care is to help inform and support caregivers as well as patients. You want to check that your care team is trained and willing to offer such support.