Sunday, April 14, 2024

What Hospice Services Does Medicare Cover

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What Is Hospice Care

Does Medicare cover hospice care

Hospice care focuses on palliative carekeeping the patient comfortable. When a person enters hospice care, the treatment of the medical condition with the goal of curing or forcing into remission ends. The specially trained team of professions focuses on providing physical, emotional, social, and spiritual support to the patient.

The team of professionals may include doctors, nurses, counselors, social workers, speech and occupational therapists, aides, volunteers, and others depending on the patients needs.

Hospice care can sometimes take place in a hospice facility but more often, care is given in the patients home and may also provide support to family or friends who are providing care.

What Hospice Services Are Included

Medicare hospice benefits typically include:

  • Medical, nursing, and social services
  • Aide and homemaker services
  • Pain relief and symptom management items & services, including prescribed drugs
  • Grief and spiritual counseling

Medicare Part A and Part B still cover other Medicare-approved services, even if unrelated to your terminal illness.

How Does Medicare Cover Hospice

Typically, hospice care is given in your home, but it may also be covered in a hospice inpatient facility. Some of the hospice services that may be covered by Medicare include:

  • Doctor services
  • Grief counseling for you and your family
  • Short-term inpatient care

Medicare does not cover room and board, ambulance transportation or treatment intended to cure your illness or a related condition while in hospice care.

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Medical Expenses For People Who Are Permanently Disabled

If youre incapable of performing everyday tasks due to an accident or disability, Medicaid will cover various medical treatments and supplies needed to keep you alive. Benefits vary depending on the severity of your impairment and how much money your spouse receives in social security benefits. For example, if you or your spouse meets one of the Social Security Administrations criteria for permanent disability, they could get up to $4,100 in monthly cash benefits. That amount increased yearly until 2016, when it reached $2,000 per month. For example, if you meet the requirements and your annual household income was between $50,250 and $62,500 before taxes in 2017, youd get approximately $11,300 in benefits annually.

If you qualify for Medicare but dont know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans. Or call 1-855-980-4104

Where You Get Hospice Care

Does Medicare Cover Hospice?

The hospice benefit allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility. If your hospice team determines that you need inpatient care, they’ll make the arrangements for your stay.

If you need to get inpatient care at a hospital, your hospice provider must make the arrangements. The cost of your inpatient hospital care is covered by your hospice benefit, but paid to your hospice provider. They have a contract with the hospital and they work out the payment between them. However, if you go to the hospital and your hospice provider didnt make the arrangements, you might be responsible for the entire cost of your hospital care.

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Does Medicare Cover Hospice At Home

Admittedly, hospice may not be a pleasant topic to discuss, but it behooves all of us to understand what this benefit offers and the coverage available to Medicare recipients.

What is Hospice?As explained by the Hospice Foundation of America, hospice offers medical care of another kind not to restore good health but rather to maintain or enhance quality of life for those with a terminal condition. With this program, an individualized care plan is developed and kept current for each patient. The plan extends beyond physical pain to address the spiritual and emotional anguish that is inevitably an outcome of terminal illness. Additionally, hospice care supports the caregiver throughout the caring period and later serves as a pillar for grief support.

Eligibility for Hospice Care Medicare BenefitsRecipients of Medicare Part A, which is the hospital insurance component of Medicare benefits, are eligible for hospice care if they submit the appropriate documentation. This includes a physician certification that states the Medicare recipient is terminally ill with a life expectancy of six months or less acceptance of palliative care, which is care to comfort versus cure and a signed statement to confirm that hospice care has been chosen over other Medicare-covered benefits to treat the illness or related conditions.

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Which Services Are Not Covered By Medicares Hospice Benefit

Medicare will not cover these items and services once your hospice benefit starts:5

  • Treatment intended to cure your terminal illness and/or related conditions
  • Prescription drugs that arent for your terminal illness or related conditions
  • Care from any provider that wasnt set up by the hospice medical team
  • Room and board*
  • Care you get as a hospital outpatient , care you get as a hospital inpatient or ambulance transportation

*If your hospice team decides you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.6

Medicare may cover these services if your hospice team arranges it or its unrelated to your terminal illness and related conditions.7

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Hospice Coverage With Medicare

All hospice-related services are covered under Medicare Part A.

If you are enrolled in a Medicare Advantage plan, these services are also covered.

If you were in a Medicare Advantage plan before your hospice care began, you can stay in that plan.

Hospice Services Covered by Medicare

  • Doctor visits
  • Hospice aide and homemaker services
  • Prescription drugs for symptom control and pain relief
  • Physical and occupational therapy
  • Medical equipment and supplies
  • Grief counseling for you and your family
  • Short-term respite care
  • Short-term inpatient care for pain and symptom management

While Medicare covers an extensive list of hospice care services, there are a few notable rules and exceptions.

Any care you receive must be arranged or administered by your designated hospice medical team.

To receive care from a different hospice, you must change your hospice provider.

You can still see your regular doctor if you select them as the attending medical professional who supervises your hospice care.

If you want to receive treatment to help cure your terminal illness, you cannot do so as a hospice patient. However, you have the right to stop hospice care at any time.

Likewise, prescription drugs meant to cure your disease instead of merely managing symptoms or providing pain relief may or may not be covered by Medicare.

Medicare does not cover room and board if you live in a nursing home or a hospice inpatient facility. However, some short-term inpatient care may be covered.

Understanding Key Differences Between The Different Types Of Medicare Plans

Medicare & You: Hospice

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.

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Are You Eligible For The Medicare Hospice Benefit

According to the official government site for Medicare, youre eligible for the hospice benefit if you have Medicare Part A AND meet all of the following conditions:

  • Your doctors certify that you have a life-limiting illness and that youre expected to live six months or less.
  • You accept palliative care instead of treatment for your illness.
  • You sign a statement expressing your wishes to choose hospice care.

Medicare Eligibility Requirements For Hospice Care

You qualify for hospice care if you have Medicare Part A and meet all of these conditions:1

  • Your hospice doctor and your regular doctor certify that youre terminally ill.
  • You accept comfort care instead of care to cure your illness.
  • You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
  • Medicare coverage starts the day you begin to get hospice care.2

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    How Do You Pay For Hospice Care

    For those not eligible for Medicare or Medicaid, payment for hospice can come from private insurance or an HMO, since these also include a hospice benefit.

    Hospices employ financial specialists to help families who do not qualify for federal assistance and do not have insurance find available resources. The payment options for these families include self-pay and charitable organizations.

    Facing a terminal illness brings with it many concerns. Paying for end-of-life care shouldnt be one of them.

    What Hospice Care Does Medicare Cover

    Does Medicare Cover Hospice?

    Hospice care from a Medicare-approved agency is usually delivered in your home or other facility where you live, such as a nursing home or assisted living facility. About half of all hospice care in the U.S. is provided in private residences. According to the National Hospice and Palliative Care Organization , all Medicare-certified hospices must provide four different levels of care.

    When hospice care starts, you, your loved ones, and your hospice team will develop a plan of care based on your terminal condition and your goals. Members of the team may include:

    • Doctors
    • Music therapists
    • Respiratory therapists

    As part of the Medicare Hospice Benefit, you will receive all items and services you need for pain relief and symptom management, including:

    • Medical, nursing, and social services
    • Drugs for pain management, including a pain pump to deliver your medications into your vein or under the skin if oral medications dont manage your pain
    • Durable medical equipment, such as a hospital bed or oxygen
    • Aide and homemaker services
    • Spiritual and grief counseling for you and your family
    • Bereavement support for loved ones as needed for up to a year.

    Hospice care is intended for terminally ill people . If you live longer than six months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that youre terminally ill.

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    Does Original Medicare Cover Hospice Care

    Original Medicare pays for hospice care that Medicare-approved hospice providers deliver.

    For Medicare to cover your hospice care costs:

    • You must be eligible for Medicare Part A
    • Both a hospice medical director and your doctor must certify that you are terminally ill and
    • You are required to sign a statement stating your decision to pursue palliative care and receive hospice care instead of using Medicare benefits to treat your terminal illness.

    Here is a summary of what hospice care services Medicare covers:

    • All services and items needed for pain relief and symptom management
    • Medical, nursing, and social services
    • Prescription drugs, but only for pain relief and symptom control
    • Durable medical equipment for pain relief and symptom management
    • Aide and homemaker services
    • Grief and loss counseling for the beneficiary and your family
    • Short-term inpatient respite care for your caregivers, which covers the beneficiaries stay in hospitals and other Medicare-approved facilities to enable your caregiver to rest

    While Medicare covers most hospice care costs, you will be required to contribute small copayments for prescription drugs for pain and symptom relief and inpatient respite care in an approved facility .

    How Do I Find A Good Hospice Agency

    If you’re on Medicare Advantage, start by asking your insurance company to help you find a good hospice agency. If you’re searching on your own, prepare a list of questions for potential hospice agencies. For example, you may want to ask:

    • How quickly do hospice staff members respond to after-hours needs?
    • What steps does your agency take to ensure quality of care?
    • How will my doctor and the hospice doctor work together to manage my care?
    • Where are hospice services provided?

    You can use this Medicare resource to locate an agency near you. This site shares agency contact information along with national surveys and ratings on hospice care to help guide your decision.

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    Does Medicare Part D Cover Hospice Care Drugs

    In general, Original Medicare will cover all the prescription drugs to reduce your pain or manage the symptoms of your illness with a small copayment.

    However, if you have prescription drugs , your Medicare Part D plan will help cover your drug costs. If the hospice does not cover some drugs, the hospice provider may also check if your Medicare Part D plan covers it.

    The Hospice Medicare Benefit Pays 100% For:

    Does Medicare Cover Hospice and Home Healthcare?
    • Medications related to the life limiting illness
    • Durable Medical Equipment related to the life limiting illness
    • Hospice Nurse – intermittent visits
    • 24 hour on-call nurse and accessibility of interdisciplinary team members
    • Hospice Aide for bathing
    • Physical, Speech and Occupational Therapist Consultation
    • Hospice Chaplain
    • Dietitian for nutritional consultation
    • Volunteers for respite, companionship, etc.
    • Inpatient Respite – up to 5 days of inpatient care provided in an authorized HoriSun Hospice Inpatient facility
    • Bereavement Services
    • Continuous Care – provided in the patient’s home on a 24 hour basis for the specific purpose of controlling acute medical symptoms. The goal of the care is to provide support to the patient/family in order to maintain the patient at home.
    • Inpatient care for symptom control related to the life limiting illness. Symptoms are not controlled and need a highly skilled approach to regain a level of comfort for the patient. Inpatient care is provided in contracted facilities only.
    • The Hospice Medicare Benefit does not include a 24 hour caregiver.

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    What Original Medicare Does Pay For

    When you start receiving the benefits for your hospice, original Medicare kicks in and covers several items related to your serious, life-limiting illness.

    However, your care MUST be from a Medicare-approved hospice provider.

    Medicare WILL Cover:

    • Your hospice care
    • Please note that you may still need to give a copayment of $5 for each prescription and products for alleviating pain and controlling symptoms while at home.
    • In addition, you may need to pay 5 percent of the Medicare-approved amount for inpatient respite careAccording to the governments Medicare site:Once you start getting hospice care, your hospice benefit should cover everything you need related to your terminal illness, even if you remain in a Medicare Advantage Plan or other Medicare health plan.

    Medicare Will NOT Cover:

    • Room and board if you get your hospice care in your home or in a senior care facility or nursing home.
    • Care that is NOT from a Medicare-approved provider.

    Check Out This Booklet that Answers Does Medicare Cover Hospice? And Other Questions

    Yes, we know. Medicare and other government programs can be confusing. Thats why you may find this booklet on Medicare hospice benefits particularly useful.

    How Much Does Hospice Care Cost With Medicare

    How much hospice care costs depends on the type of illness and how early patients enter hospice. In 2018, the Society of Actuaries estimated that hospice patients with cancer received Medicare Part A and Part B benefits totaling around $44,030 during the last 6 months of their lives.

    That figure includes the cost of inpatient hospital treatments, in addition to at-home hospice care.

    The good news is that there are no deductibles for hospice care under Medicare.

    Some prescriptions and services may have copays. Prescriptions for pain medications or symptom relief may carry a $5 copay. There may be a 5 percent copay for inpatient respite care if you are admitted to an approved facility, so your caregivers can rest.

    Other than those instances, you wont have to pay for your hospice care.

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    Differences Between The Medicare Hospice Benefit And Regular Medicare

    • Medicare hospice coverage is limited to beneficiaries who are terminally ill.
    • Hospice coverage is for pain and symptom management and comfort, not for curative treatment of the underlying terminal illness.
    • Hospice coverage is holistic. Not only is medical care covered, but so are social work services, chaplain services, bereavement services and homemaker services.

    A Comparison of Medicare Home Health Benefits and Hospice Benefits

    Not Covered Covered, during periods of medical crisis

    ¹ There are additional services that can be provided in the home, but are not included in the home health benefit. Medicare will pay for reasonable and necessary home health visits if all the following requirements are met: 1. Patient needs skilled care 2. Patient is homebound 3. Care is authorized by physician and 4. Home Health agency is Medicare-certified. .² Medicare will pay for hospice care if all the following requirements are met: 1. Prognosis that life expectancy is 6 months or less. 2. Terminal illness is certified by physician 3. Patient elects hospice benefit 4. Care is specified in the hospice plan of care and 5. Hospice program is Medicare-certified. .

    What Is Inpatient Hospice Care

    Does Medicare Cover Hospice?

    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.

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