End-of-life care involves a wide range of services, and so it requires special coverage rules through Medicare Part A. A recipient may not see much change in terms of how their services are provided, they should understand what their cost-sharing obligations may be while receiving hospice care.
What is Hospice Care?
Whether it’s provided at home, in a hospital or skilled nursing facility, hospice care is offered to patients who are no longer seeking treatment to cure their terminal health condition. A team of hospice care specialists and volunteers provide these patients with support to prevent pain and discomfort, as well as ensure the quality of their life retains dignity and a sense of peace. Services may involve psychological or spiritual support according to the patient’s own preferences.
Hospice care involves supporting the patient’s family, helping them to fulfill their loved one’s wishes for end-of-life decisions and connecting them with any community services they may need. Families may also receive respite assistance if they are a primary caregiver for a terminally ill loved one. This allows the patient to receive a consistent level of care and provides family members an opportunity to manage other priorities without compromising their loved one’s care.
In most cases, hospice care is recommended for patients who are not expected to live beyond six months without active treatment to fight their illness. Some patients may choose to leave hospice care and resume active treatment for their illness.
What Does Medicare Cover during Hospice Care?
Medicare coverage for hospice care is provided through Part A, so recipients must be Part A beneficiaries to qualify for hospice care coverage. Part A will cover its portion of hospice costs if a hospice or primary care doctor certifies that a patient is terminally ill and their life expectancy is six months or less, the patient chooses palliative care instead of treatment intended to cure their illness and the hospice care is through a Medicare-certified provider.
Once these requirements are met, hospice care is provided according to the level of care the patient needs. This follows four basic arrangements for care:
Routine home care. This is the most basic and most comfortable level of hospice care. Patients receive nursing and counseling services in the home, as well as physician visits and any medications they need to control symptoms of their illness and remain comfortable. While Medicare does not provide room and board payment during routine home care, the cost of all other hospice-related services are covered. Prescription medications given to manage symptoms of the terminal illness may require a copayment of up to $5 for each medication.
Continuous home care. While routine home care means the team of hospice professionals visits intermittently according to pre-scheduled needs for services, continuous home care is available when a terminally ill patient is experiencing excessive difficulty with their symptoms or system of care. This may be due to a loss of primary caregiver support or pain that is not responsive to palliative care. This level of care is reevaluated for need every 24 hours.
Inpatient hospice care. Patients who are experiencing a severe degree of difficulty managing the symptoms of their illness and maintaining comfort in their home or hospice center may need to be admitted for round-the-clock care in a hospital setting. This may be necessary if their care requires the use of supplies or equipment that are not available in the home.
Respite care. Hospice patients who do not qualify for continuous home care or inpatient care may still need the services provided through respite care. Respite care professionals take the place of personal caregivers when the personal caregiver, usually a close family member, is not available or needs time to tend to their other priorities. Recipients may need to pay a percentage of the Medicare-approved rate for inpatient respite care.
Throughout the hospice care experience, providers will bill Medicare Part A directly for their services unless there is a copayment portion to be paid by the patient.