Hospice care comes at a time when families need help the most. A hospice program not only provides palliative health care services for the terminally ill patient, but it also provides support to the patient’s loved ones.
Palliative care focuses on providing comfort, quality of life, and pain relief rather than life-prolonging care that can be onerous and too difficult for the patient and family members.
For family members who have a loved one ready for hospice, it’s comforting to know that Medicare provides assistance for the beneficiary during hospice care. This article has important information about what services are included in Medicare’s coverage, qualification requirements, and what Medicare pays for.
Qualification requirements for Medicare hospice care
If you or your loved one is terminally ill and needs hospice care, they must be enrolled in Medicare Part A (hospital insurance) and meet all the following conditions to qualify for it:
- The beneficiaries’ hospice physician and regular physician must certify that they are terminally ill – a six-month or less life expectancy.
- The beneficiary must accept palliative care rather than curative care for the illness.
- The beneficiary must sign a statement that clearly states they choose hospice care over other care covered by Medicare for treatment of the terminal illness and other related conditions.
How does Medicare cover hospice care?
If you have Medicare and qualify for hospice care, you can get it at home, in another facility where you live, such as a nursing home, or in an inpatient hospice care facility.
While you are in hospice care, if you need medical services that are unrelated to your terminal illness, your Original Medicare benefits cover them.
When you are in hospice care you have a team of health care professionals who create a plan for your care that includes all, or some, of the following services:
- Doctor’s care
- Nursing and medical care
- Durable medical equipment needed for pain relief and symptom management
- Medical supplies such as catheters, etc.
- Pain management drugs
- Nursing aide and homemaker assistance
- Physical therapy, occupational therapy, and/or speech-language pathology
- Social services care
- Diet and nutrition counseling
- Spiritual and grief counseling for the patient and family members
- Inpatient care for pain and symptom management on a short-term basis in a facility that accepts Medicare assignment.
- Inpatient respite care in a Medicare-associated facility. This is provided to give your main caregiver a rest and is arranged by your hospice provider. Respite care length is up to five consecutive days. You can get this benefit more than once, but only on an occasional basis.
- Miscellaneous services that Medicare covers for pain and symptom management when related to your terminal illness and related conditions. These services must be recommended by your hospice care team.
It’s important to note that your Original Medicare benefits don’t cover the following services when your hospice care coverage begins:
- Curative treatment for your terminal illness or related conditions.
- Prescription drugs to cure your terminal illness or related conditions.
- Care from a hospice provider that hasn’t been set up by your hospice team.
- Room and board at your home or other facility you consider your home.
- Hospital outpatient care, hospital inpatient care, and/or transportation by ambulance unless it has been arranged by your hospice team, or it is necessary to treat a condition that is unrelated to your terminal illness or related conditions.
What does Medicare pay for regarding hospice care?
If you have coverage through Original Medicare, your benefits pay 100 percent of the cost of your hospice care. You are responsible for a copayment of up to $5.00 for your prescriptions for outpatient drugs necessary for pain and symptom management.
While it isn’t common, if your hospice benefit doesn’t cover a prescription drug you need, the hospice provider can check on whether you have coverage through your Medicare Part D plan. You should be notified by your hospice provider if your drugs aren’t covered. In some instances, you may need to pay 100 percent of the cost of the drugs.
For inpatient respite care, Medicare pays for 95 percent of the final, approved cost of the care, and you are responsible for the remaining five percent.