Hospice Care and Medicare Coverage

Like many people, you’ve probably heard of “hospice,” but may not know exactly what it is or what’s involved. It is a type of care given to terminally ill people when they no longer respond to medical treatments that were meant to cure them. Hospice is a “concept of care” or a unique way of caring for dying patients and their families. The idea is to improve the quality of the dying person’s last days and allow them to die with dignity.

What is Hospice Care?
Hospice is not a place to receive care, like a hospital. In fact, most hospice care takes place in your home. It’s a program that believes dying people should have as much comfort and support as possible at the end of their lives. Although there are hospice facilities, most people choose to stay at home where they are most comfortable. Hospice care can also be provided in a family member’s home or in a nursing home.

It’s important to know that hospice care does not prolong a terminally-ill person’s life or in any way make them die faster. A team of specially trained hospice staff and volunteers provide all the services that the person and their family will need.

All of the person’s needs are addressed—medical, physical, emotional, social, and spiritual. Hospice also provides support to the person’s family or caregiver. One of the most important parts of the care hospice provides the patient is pain management with medications. But hospice workers also help with daily living needs like bathing.

How Do you Get Hospice Care?
If you are terminally ill, you may be referred by your doctor into hospice when your life expectancy is less than six months. You, as the patient, have the right by law to make the decision. When you and your family are considering hospice, but are uncertain, a hospice worker can conduct an evaluation at your home and tell you if it’s the right time, or if a later date would be appropriate.

You can choose a hospice program in your community. Get recommendations for programs in your area from your doctor, a hospital, nurse, social worker, or family and friends. It’s important that you choose a program that has been Medicare-certified because Medicare will pay for most hospice care.

What Happens When you Enter Hospice?
Here’s what will happen when you enter a hospice program:

When you are admitted to a hospice program, the hospice staff will contact your doctor to make sure that he or she agrees that hospice is the right choice for you.You’ll be asked to sign consent and insurance forms.Your hospice provider will determine what will be necessary for your care—make arrangements to get any equipment, etc.This is the best time to ask any questions you might have about how the program will work.The hospice team will make an individualized care plan that will also determine how much caregiving you will need from your family or caregivers.The hospice staff will visit often and will always be available to answer medical questions.

Who is on the Team and What do they Provide?
Your care will be provided by a doctor, a nurse, social workers, counselors, home health aides, clergy, therapists, and volunteers. Each provider has a different role in your care and has special expertise in both their area and in hospice care. Hospice programs provide medications, medical equipment, and other services that are involved in working with a terminal illness.

How Can I Make Sure My Hospice Care is Covered by Medicare?
As with all medical services covered by your Medicare insurance, there are certain things you will need to do so that your hospice care is paid for. Hospice care is paid for under Medicare Part A, which is Hospital Insurance. Below are the Medicare coverage guidelines:

The terminally-ill person is eligible for Medicare Part AThe person entering hospice care has less than six months to live due to a terminal illness and which is determined by their doctor.The terminally-ill person must sign a statement that hospice care has been chosen over other Medicare benefits such as assisted living or hospital care.Medicare will still pay for covered benefits for any health problems that aren’t related to the terminal illness.

What Does Medicare NOT Cover?
Medicare will not pay for the following:

Any treatment that is meant to cure your illnessPrescription drugs to cure your illness instead of controlling your symptoms and pain reliefCare from any provider that wasn’t provided by the hospice medical teamCare in an emergency room, inpatient facility, or ambulance transportation, unless it’s arranged by your hospice team or is not related to your terminal illness

Other Things to Consider
Hospice care is not just for the terminally-ill person. Losing a family member that you love or someone for whom you’ve cared for is very difficult and painful. Hospice recognizes how important it is for you to have the support that you need. That’s why they provide respite care and counseling. Take advantage of all the services and support that the hospice team gives you. They understand what you are going through because they are experts.

For additional information about all services provided by hospice under Medicare, please refer to www.medicare.gov

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