Yes, Original Medicare comprehensively covers hospice care for beneficiaries who meet certain requirements. Hospice is supportive care that focuses on comfort and quality of life for with a life expectancy of less than six months.
Knowing you or your loved one may need hospice care can be difficult and stressful. This article will help you understand how hospice can be paid for by Medicare, what’s included in the hospice benefit and what’s not.
How Do You Qualify for the Hospice Benefit?
There are three main criteria to qualify for the Medicare hospice benefit:
1. Your Doctor Certifies a Terminal Illness
A patient is considered terminally ill if they have a life expectancy of six months or less, as certified by a doctor, if the disease runs its normal course. If a patient lives longer than six months, the doctor can re-certify eligibility if they still consider the patient to be terminally ill. Doctors use varying signs to determine life expectancy like progressive weight loss, recurring infections, general weakness and fatigue and difficulty with activities of daily living.
2. You Elect Supportive Treatments Rather Than Curative Treatments
Hospice care is focused on comfort and quality of life rather than care that aims to cure disease. The hospice benefit includes pain management medication, nursing care and more to manage the disease and allow the patient to live where they most want to be at the end of life. Patients can also change their mind at any time and elect to return to curative treatments and stop hospice care.
3. You Choose a Medicare-Certified Hospice Provider
Lastly, you must choose a hospice provider that has met Medicare’s requirements and undergone certification. The Medicare Care Compare website is an easy-to-use tool to find Medicare-approved agencies near you. You can also compare quality scores to ensure the agency you choose can fully honor your wishes and achieve your goals.
What Services Does the Medicare Hospice Benefit Cover?
The hospice benefit is among Medicare’s most unique offerings in that it treats the whole person, addressing the patient’s medical, emotional, social and spiritual needs. Each patient’s hospice care plan will differ depending on their conditions, needs and how they want to spend the time remaining to them. Hospice agencies also differ on the specific services they provide.
These hospice services are covered by Medicare if needed in the plan of care:
Pain Management
The hospice team may recommend medications to ensure that pain and other symptoms are manageable with the goal of keeping the patient alert and as comfortable as possible.
Hospice Aide Support
Hospice aides help patients with activities of daily living like bathing, preparing food, toileting and others.
Social Work Support
Social workers support both the patient and the family during this time, bolstering emotional support and counseling on how to cope with grief, help with end-of-life conversations and planning, funeral arrangement support and associated paperwork and referrals to community resources like grief counselors or clergy members.
Nursing Care
The hospice nurse is a key member of the hospice care team. The nurse provides much of the at-home care to manage pain and other symptoms, making regular visits to assess the patient and coordinate care with other members of the team. Hospice agencies like Amedisys also support 24/7 on-call nursing assistance. Nurses can also specialize in effective wound care to provide relief from ulcer or other wound discomfort.
Volunteer Companionship
Hospice volunteers bring joy to patients with regular visits to assist with practical needs or, most often, for pure companionship.
Chaplain Spiritual Support
Depending on the patient’s and family’s spiritual needs and religious beliefs, hospice care can include chaplains to provide spiritual care.
Bereavement Support
Families can expect up to 13 months of bereavement support after their loved one has passed from a trained bereavement coordinator.
Therapy Services
Some patients may require therapy services, including physical therapy, occupational therapy and/or speech therapy to support well-being and comfort.
Specialized Programs
Each hospice provider may also offer specialized programs for certain patients and families. For example, Amedisys offers a unique dementia specialty program for patients with advanced dementia. Amedisys care centers are nearly all certified in the We Honor Veterans program designed to treat veterans’ unique end-of-life needs like managing traumatic memories, chronic pain and depression.
What Does Medicare Not Cover for Hospice Care?
Hospice care is supportive, not curative. The Medicare hospice benefit does not include the following services:
- Curative treatments
- Curative prescription drugs
- Medical care not prescribed or provided by the hospice medical team
- Room and board at any in-patient skilled nursing facility or nursing home where you live
- Emergency room transportation or care unless it is arranged by your hospice team or unrelated to the terminal illness
Are There Out-of-Pocket Expenses Outside the Medicare Hospice Benefit?
While Original Medicare comprehensively covers your hospice care, there may be additional expenses, like copayments on pain management prescription drugs or a percent of the Medicare-approved amount for any inpatient respite care and room and board at any facility in which you receive hospice care.
How Long Does Medicare Cover Hospice?
Patients can receive hospice care under Medicare for two 90-day periods initially and then as many 60-day periods they qualify for afterwards.
You can revoke the hospice benefit at any time.
Unfortunately, most hospice patients do not take advantage of receiving hospice care for the full time allowed. In fact, nearly one-third of patients are on hospice for just seven days. Hospice can help reduce hospitalizations, manage pain, bolster emotional and spiritual support, help achieve dreams and keep patients comfortable at home.
If you think you or your loved one is ready for hospice care, take our quiz to determine if it’s the right choice and to get in touch with our dedicated hospice specialists.
