Medicare offers coverage for hospice care
July 1, 2022 | View PDF
Hospice is a program of comfort care and end-of-life pain management for those with a terminal illness. In this month’s review of Medicare-covered hospice, we speak directly to patients as if they are the ones taking these actions or making these decisions. However, discussions about hospice often involve caregivers and family members as well. If you are a caregiver, family member, or a patient’s appointed representative, you may be leading these conversations or decisions, rather than the patient. You are also encouraged to call one of our certified counselors at the Medicare Information Office (MIO) and/or use the hospice care provider locator available on the Medicare.gov website.
Medicare’s hospice benefit is primarily home-based and offers end-of-life palliative treatment. Palliative treatment provides pain management services, rather than curative care. The goal of hospice is to help you be as comfortable as possible, not to cure an illness. Services covered under the hospice benefit include skilled nursing and skilled therapy services, hospice aides and limited homemaker services, medical supplies, durable medical equipment, respite care and short-term inpatient care. Hospice coverage also includes prescription drugs needed for pain and symptom management related to the terminal condition, while a Part D prescription drug plan may cover medications that are unrelated to your terminal condition. To elect hospice:
1. You must be enrolled in Medicare Part A.
2. You must have a doctor certify that you have a terminal illness, meaning a life expectancy of six months or less.
3. You or your appointed representative must sign a statement electing to have Medicare pay for palliative care, rather than curative care.
4. You must receive care from a Medicare-certified hospice agency.
Where the care takes place
Hospice generally takes place at home, with your hospice provider sending aides, nurses and/or skilled therapists to provide the pain management services in your place of residence, which might be a facility, like a nursing home, if that is where you normally reside. Hospice can sometimes take place at an inpatient facility, if your hospice provider determines inpatient care is necessary for you. If your hospice provider determines that you need inpatient care, they must be the one to make the arrangements. The cost of your inpatient stay is covered by the hospice benefit, but if you go to the hospital for hospice care and your hospice provider didn’t make the arrangements, you might be responsible for the full cost of the stay.
If you are interested in Medicare’s hospice benefit, ask your health care provider whether you meet the eligibility criteria for Medicare-covered hospice care. If so, they can contact a Medicare-certified hospice on your behalf. Once you have found a Medicare-certified hospice, the hospice medical director and your regular doctor, if you have one, will certify that you are eligible for hospice care. Afterwards, you must sign a statement electing hospice care and waiving curative treatments for your terminal illness.
Your hospice team must consult you – and your primary care provider if you wish – to develop a plan of care. Your team may include a hospice doctor, a registered nurse, a social worker and a counselor. Medicare covers hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. Doctor’s certification is necessary for each benefit period.
Change of mind
If you decide you want curative treatment, you have the right to stop hospice care at any time. Speak with your hospice doctor if you are interested in seeking curative treatment. If you end your hospice care, you will be asked to sign a form that includes the date such care will end. If you choose to end hospice care, make sure you provide your Part D plan with written proof of the change so that it can update your status in its system. You can elect hospice again later if you continue to meet the eligibility requirements.
For answers to any Medicare related questions, please feel free to contact the State of Alaska’s Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers (MIPPA) program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor at the Alaska Medicare Information Office.