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.
Facts and Figures
According to the 2018 edition of facts and figures published by NHPCO (National Hospice and Palliative Care Organization), most hospice care is provided in the patient’s home. In this instance, home refers not only to private residences but any place the individual thinks of as home, which may include nursing homes and residential facilities as distinguished from hospitals and free-standing hospice centers. The two types of hospice care that can be delivered at home are routine hospice care (RHC) and continuous home care (CHC). RHC is the most common. CHC addresses pain management, which involves mostly nursing care, augmented with caregivers and hospice aides. The 2019 revision of NHPCO Facts and Figures reveals that over 90% of Medicare spending for hospice care was for routine and continuous home care combined. The remaining expenditure went toward inpatient respite care (IRC), which provides temporary relief to the caregiver, and general inpatient care (GIP), which is delivered either in a hospital, hospice residential center or nursing facility.
Eligibility for Hospice Care Medicare Benefits
Recipients 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.
What is Covered and What is Not
As a reminder, Original Medicare is the traditional Medicare program managed by the U.S. government as opposed to Medicare Advantage, which is offered by private insurance companies that provide Original Medicare coverage plus additional benefits and services. All approved hospice care costs are covered under Original Medicare, excluding room and board when care is delivered where you reside. There is a five-dollar co-payment for covered pain relief prescription drugs. For inpatient respite care, you may be responsible for 5% of the Medicare-approved amount.
Hospice coverage does not include any treatment intended to cure the illness your doctor certified as terminal; prescription drugs for cure versus symptom control or pain relief; care set up by any party outside the hospice medical team; room and board outside an approved hospice facility; and hospital inpatient/outpatient care or ambulance transportation. If the hospital care or ambulance transportation is coordinated by the hospice team or is unrelated to the terminal illness, an exception may be granted.
History of Hospice Care
It has been over 40 years since the first hospice was introduced in the United States. In 1982, the Medicare hospice benefit was created, and in November of that year, National Hospice Week was instituted. By 2005, the number of hospice provider organizations grew to 4000. Duke University published a study in 2007 that concluded hospice services save money for Medicare and bring quality care to patients and families. Over the years, the focus and appreciation of end-of-life care, quality and dignity has continued to grow.