Hospice Care & Medicare Coverage Under Federal Law
When an elderly person approaches the end of their life, they may prefer hospice care to intensive medical treatment. Hospice care is designed to make a patient comfortable and preserve their dignity as much as possible, rather than trying to pursue a cure. A patient is eligible for hospice care if their doctor certifies that they are unlikely to live for six months or more. (This is impossible to predict with certainty in most cases, so sometimes a patient will enter, leave, and reenter hospice care.) Services may be provided at the home of the terminally ill person, or they may be provided at a specific hospice facility or at a hospital or nursing home. Sometimes hospice care may be provided to family members of the terminally ill person as well.
While hospice care is less technically sophisticated than efforts to cure a patient, it does provide medical and nursing services, sometimes in coordination with the patient’s doctor. It may include psychological and religious counseling, as well as assistance with the patient’s financial affairs. Hospice care often involves assistance with the activities of daily living. Patients still will receive their medications and take advantage of therapy and standard forms of medical equipment, such as wheelchairs and oxygen tanks. However, the emphasis rests on stability and comfort, rather than aggressive intervention.
Choosing a Hospice Care Provider
You may want to ask for references from family members and friends who have sought hospice services for their loved ones. Institutional resources that may be helpful include the National Hospice and Palliative Care Organization, the Hospice Association of America, and the Office on Aging in your area. If an elderly person already is receiving treatment in a hospital or a nursing home, they may be able to get recommendations from their doctors or staff members at the facility. Sometimes a hospital or long-term care facility, or the discharge planner there, will have an ongoing relationship with a certain hospice, and the continuity can be reassuring to a patient. However, they should be aware that their current treating doctor may or may not continue treating them if they shift to hospice care.
Medicare Coverage for Hospice Care
In addition to covering hospital costs, Medicare Part A usually will cover hospice care as long as the program is certified by Medicare. A patient cannot receive hospice care from multiple programs at the same time. They must provide Medicare with a statement from their doctor and the hospice medical director that they are not expected to live for six months or more, due to a terminal illness. In addition, they will need to sign a statement that verifies that they will be replacing their standard Medicare benefits with hospice care. If an unrelated illness or health issue arises, Medicare will provide coverage for treating it.
Medicare coverage will last for 210 days of hospice care, separated into two 90-day periods and a 30-day period. A patient can extend any of these three periods if their doctor states again that they are suffering from a terminal illness. (They may be able to extend coverage indefinitely, but this is unusual.)
Medicare does not cover all hospice services. A patient will need to pay for their room and board at a hospice facility, as well as any services that are meant to cure their illness or that are unrelated to improving their comfort. Also, Medicare pays only a certain amount for the services that it does cover, meaning that a patient will be responsible for covering the remainder on their own. Services covered by Medicare (up to a fixed amount) include the costs of medical equipment and supplies, medications, nursing, therapy, counseling, housekeeping, and short-term hospital care.
