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Medicare’s hospice benefit
Choosing hospice care isn’t about giving up. It’s about making every day count. Terminally ill people who make the choice receive care for their physical, emotional, social, and spiritual needs. They’re no longer seeking a cure, but they do want to live out their last weeks and months as comfortably as possible and with dignity.
Medicare’s hospice benefit is 30 years old this year and has helped millions of Americans and their families cope with the final stages of terminal illnesses.
To qualify, you must be eligible for Medicare’s Part A hospital insurance, and your physician and your hospice medical director must certify that you have six months or less to live, assuming your illness runs its normal course.
You also must sign a statement choosing the Medicare hospice benefit and another statement that you understand you’re forgoing curative treatment for your terminal condition.
Hospice programs follow a team approach. The specially trained team typically includes doctors, nurses, counselors, and social workers, among others. A doctor and nurse are on call 24-7 to care for you and support your family when you need it.
The hospice benefit allows you and your family to stay together in the comfort of your home, unless you require hospital care. If your hospice team determines you need inpatient care at some point, it will make the arrangements for your stay.
Hospice’s main goal is to relieve your pain and manage your symptoms. As long as the care comes from a Medicare-approved hospice, Medicare covers the physician services, nursing care, drugs, medical equipment and supplies, and physical and occupational therapy.
Though the hospice benefit is part of original Medicare, it’s also available to anyone with a Medicare Advantage plan. And both original Medicare and Medicare Advantage will continue to pay for the treatment of other conditions unrelated to your terminal illness.
Medicare understands that your family occasionally needs a rest from caregiving. So you can request to stay up to five days at a time at a hospice facility, hospital, or nursing home. For that, you pay 5 percent of the Medicare-approved amount for respite care.
Overall, you pay almost nothing for your hospice care. There is no deductible. Besides your 5 percent share for the inpatient respite care, your only expense is the $5 or less you pay for each prescription drug you take to relieve pain or manage your symptoms.
You can receive hospice care as long as you’re recertified. After 90 days of care, you’re re-evaluated by the hospice’s medical director or other hospice doctor to determine if the care is still appropriate.
Another re-evaluation is done after another 90 days and then every 60 days. If your health improves or your illness goes into remission, you may not need to remain in a hospice program. In those cases, you’ll return to your previous Medicare coverage. And if someday your condition worsens, you can go back to hospice care.
Beneficiaries wanting to learn more about hospice programs in their area should talk to their doctor or call their state’s hospice organization or health department. Their physician will also help determine whether a particular program has been approved by Medicare.
When considering and choosing a hospice program, ask these questions: What kind of training does the hospice provide its caregivers? How does the hospice staff respond to after-hour emergencies? What measures are in place to ensure quality care? How does the hospice involve the family in planning the care?
Even if you’re enrolled in a Medicare Advantage managed care plan, you can still choose hospice care from any available Medicare-approved hospice.
For more about Medicare’s hospice benefit, visit Medicare’s website site at medicare.gov or call Medicare’s 24-7 customer service line at 1-800-633-4227. A Medicare publication, titled “Medicare Hospice Benefits,” can also be downloaded from the website or requested by phone.
Bob Moos is the public affairs specialist with the Centers for Medicare and Medicaid Services, Region 6.
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