Since 1967 when modern hospice care was first created, it has provided comfort and an improved quality of life for people who are facing the final phase of a life-limiting illness. For those who are no longer seeking curative treatment, hospice care provides pain and symptom relief, as well as emotional and spiritual support for the patient and their families.
In the United States, the Medicare provides coverage for hospice care that takes place at an inpatient facility or in the patient’s home. If you, a family member, or someone in your care is facing a terminal prognosis, you will need information on hospice care and your Medicare coverage.
Medicare Coverage for Hospice Care
Medicare recipients who have Original Medicare Part A, are eligible for the hospice benefit if they have certification from their physician that their life expectancy is no more than six months. Patients must also sign a statement saying they choose hospice care rather than curative treatment for their illness. It is also possible for patients to decline the hospice benefit after care has begun but have the right to sign up for it again at any time.
If a beneficiary has a Medicare Advantage plan, hospice care is covered by Original Medicare insurance Part A and there may be additional benefits which depend on what the individual policy offers. Even though Original Medicare covers all costs for hospice care, there may be a copayment for prescription drugs or other medications when the patient is receiving care at home. This copayment is no more than $5.00 per prescription. They may also have to pay 5 percent of the Medicare-approved amount for inpatient respite care.
Without Medicare coverage, or another form of health insurance, the cost of hospice care is high. In some facilities the average cost of inpatient care is around $10,000.00 per month. The final cost depends on the level of care that is necessary. At home care usually runs around $150.00 per day, and general inpatient care is about $500.00 per day.
How Long Will Medicare Coverage Last for Hospice Care?
When beneficiaries sign up for hospice care there is a requirement for certification from a health care provider that life expectancy is no more than six months. That is why many people are under the impression that hospice care is only available for a six-month period. That is not the case. After the initial six-month period, hospice care can continue if the medical director, or a doctor of the hospice facility, re-certifies that the patient is terminally ill.
Medicare gives coverage for hospice care in benefit periods. Initially, a patient can receive hospice care for two 90-day benefit periods. After that, they can get hospice care for an unlimited number of 60-day benefit periods. When the first 90-day period begins, the patient’s doctor or hospice doctor must sign the certification that the patient is terminally ill and expected to live six months or less. This must be done again at the beginning of each benefit period afterwards. This recertification allows the patient to remain in hospice care. For every benefit period of hospice care, the patient has the right to change hospice providers one time.
If a patient no long needs hospice care because of improvement in health or remission, the patient can stop hospice care. Basically, patients have the right to terminate hospice care at any time. If it is terminated, they sign a form declaring the date the care ends.
If you, or someone you love is coping with a terminal illness, having all the essential information about hospice care will help relieve some of the stress. Your physician or a hospice care provider can discuss all the details you will need during this difficult time.