Coffee & Coverage: Hospice Care

medicare coverage, hospice care

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What is hospice care?

Hospice care is for people who are chronically, terminally, or seriously ill. This type of care is usually long-term and takes place in the home rather than in a hospital or another medical facility.

When someone makes the choice to go with hospice care, in most cases they have stopped trying to find a cure for their illness, and they want care that will keep them comfortable and in their home.

What does Medicare cover?

Medicare covers many options through Medicare Part A. You can qualify for coverage as long as you meet requirements deemed necessary by your doctor, accept palliative care, and sign an agreement that you are seeking hospice care rather than treatment for your condition.

In the beginning, your regular doctor and hospice doctor have to certify you as terminally ill. Following that, at the beginning of each benefit period, the hospice doctor must recertify you. Typically hospice is for those who have 6 months or less to live. You can get hospice care for two 90-day periods, then an unlimited number of 60-day periods.

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The following list is what Medicare covers:

  • Doctor services
  • Nursing care
  • Medical equipment, like wheelchairs or walkers
  • Medical supplies, like bandages or catheters
  • Prescription drugs for symptom control or pain relief
  • Hospice aide and homemaker services
  • Physical therapy services
  • Occupational therapy services
  • Speech-language pathology services
  • Social work services
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term inpatient care for pain and symptom management
  • Short-term respite care- If your usual caregiver (like a family member) needs a rest, you can get inpatient respite care in a Medicare-approved facility (a hospice inpatient facility, hospital, or nursing home). Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but it can only be provided on an occasional basis.
  • Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team

What does Medicare not cover?

While Medicare offers many options when it comes to hospice care, there are things that Medicare will not cover.

Some of the following are things Medicare will NOT cover during hospice:

  • Treatment intended to cure your terminal illness and/or related conditions.
  • Prescription drugs to cure your illness (rather than for symptom control or pain relief).
  • Room and board, if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
  • Care you get as a hospital outpatient (emergency room), care you get as a hospital inpatient, or ambulance transportation unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

The only costs you should have for hospice care are your copays for prescriptions. You may also have to pay five percent of the Medicare-approved amount if you receive inpatient respite care. As stated above, Medicare does not cover the costs of room and board if you spend time in the hospital.

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