Does Medicare Cover Hospice?

Whether you are a senior or a caregiver, understanding hospice, the costs associated with it and what your insurance covers is extremely important. As seniors reach the final stages of their life, hospice care becomes a not-so-distant possibility. When doctors and other professionals in the senior’s health team determine that the patient has the life expectancy of six months or less – declaring the patient as terminally ill – hospice care can begin. This means that instead of getting care that attempts to cure their illness, seniors agree to comfort or palliative care. Consequently, Medicare will begin to cover hospice care instead of the treatments seniors were receiving before. This article will tell you all about how Medicare can help offset the costs of hospice care. 

What does medicare cover for hospice?

Medicare coverage ensures that you pay nothing for hospice care. For each prescription of outpatient drugs that the senior may need for managing pain, seniors may need to pay up to $5. Hospice benefits cover drug costs in most cases and for exceptions you can contact your plan provider to see if Part D can help instead. For some cases, seniors may have to pay 5% of the overall amount for inpatient respite care that is approved by Medicare. 

In addition to paying for the pain management drugs, Medicare coverage extends to homemaker and aide services, medical equipment and all other items and services used for symptom and pain management, general nursing and medical services, and any other aspects of hospice care – including grief counseling. 

The specific amount of money that seniors may have to pay for their service will depend on what services patients need exactly, which facility they will be staying at, what their doctor’s fees are, what other insurance seniors have, and more. Though Medicare covers the majority of services related to hospice care it does not include room and board when the care is provided at your home or a different place where you live. 

What is included in hospice care?

Each individual senior will receive a personalized plan from their hospice care team, depending on what illness they are battling with and what other related conditions they have. This plan can include physical therapy, nursing services, necessary medical equipment and drugs for pain relief, doctor’s services, occupational therapy, social services, dietary support, spiritual and grief counseling, medical supplies, speech therapy, and short in-patient care. 

In-patient respite care can be provided to patients several times but only on an occasional basis. It is often arranged by the hospice provider and allows the usual caregiver to take a break. In order for hospice care to be covered by Medicare, the care facilities must be approved by them. These facilities can be specific to hospice care, hospitals, nursing homes, or other accepted options. 

The only people who can declare that seniors are terminally ill are hospice and regular doctors. If the patient lives past the expected six months, they can keep receiving hospice care as long as the approved medical staff continues to state that the senior is terminally ill. 

What Medicare won’t cover

Once seniors accept hospice care, there are things that medicare will no longer cover. Medicare will no longer pay for any services that are used to treat the patient’s terminal illness or other related conditions. However, it is important to remember that if seniors decide that they wish to continue treatment, they have the right to stop hospice care at any time. Going along with this, Medicare will also no longer cover prescription drugs that attempt to cure the senior’s illness. 

It will also be necessary that the hospice provider is set up by the hospice medical team and that patients receive hospice care from the provider they choose. Even though seniors cannot receive hospice care from anywhere they do not have picked as a provider, they can still retain the same doctor or nurse that they had before beginning hospice. 

As mentioned before, Medicare will also not cover room and board if the hospice care is provided in the patient’s home or if the patient lives in a nursing home or a hospice inpatient facility. Hospital outpatient or inpatient care, ambulances, or anything else unrelated to the hospice care specifically will also not be covered. 

Does Medicare cover hospice care in a nursing home?

Some portion of the senior’s stay in a nursing home is covered under Medicare Part A. For those staying in a skilled nursing facility, there are several necessary conditions. Before seniors can request coverage for a nursing home from Medicare, they must have been in the hospital for three or more days. They must also begin the care within thirty days after they are discharged from the hospital. 

In addition, the senior’s doctor must find it necessary that the senior receive skilled nursing or rehabilitation services daily. The nursing home that seniors begin to live in has to also be approved by Medicare. 

Medicare will pay for the maximum of 100 days in a benefit period if the senior meets the above-mentioned conditions. A benefit period is the time between starting nursing care and reaching 60 days after the hospital discharge. 

If all of these conditions are met, Medicare will help pay for ambulance transportation, dietary support and counseling, medical and social services, semi-private rooms, meals, prescription drugs, skilled rehabilitation and nursing services, medical supplies and equipment, and other aspects of care such as lab tests. 

Does medicare cover hospice care at home?

Home care is partially covered by both Medicare Part A and B. This can include rehabilitative care, skilled nursing, and other health services necessary to treat an illness or injury. Unfortunately Medicare will not cover daily activities such as bathing, dressing, hygiene care, eating, and more. 

There are four major conditions that home care must meet for Medicare to cover it. Doctors have to order medical care for seniors in their home and create a care plan. Patients have to be in need of a skilled nurse, a physical therapist, or an occupation and speech therapist. These previous services can only be paid for on a part-time basis. Seniors have to be homebound, showing that patients cannot leave their home due to injury or illness. Finally, all home care must be provided from a Medicare-approved home-healthcare agency.  

Care in a Hospital

For those seniors that require care in a hospital – including stays in psychiatric hospitals, Medicare Part A can help. Once patients pay their deductible, Medicare covers the rest of the hospital bill for stays that last up to 6o days in a single benefit period. If the patient’s hospital stay is prolonged past the 60 days, seniors will be required to pay more. 

For hospital care, Medicare Part A can help with physical therapy, drugs and other medical services in the hospital, nursing services, semi-private rooms and meals, resident and intern services, follow-up care planning, wheelchairs, medical supplies and other equipment. It cannot help with private rooms, televisions or telephones, or private nurses. 

Conclusion

Whether you are a senior or their caregiver reading this article, it can be extremely overwhelming to figure out hospice care. We hope that this article about the different elements of how Medicare and hospice care interact will be helpful. 

Sources:

1. Does Medicare Cover Hospice Care, Medicare Resources, www.medicareresources.org
2. Hospice Care, the Official U.S. Government Site for Medicare,  www.medicare.gov