Hospice Medicare benefit is a part of Medicare that pays for hospice care and the benefit covers any care that is reasonable and essential for easing the course of a terminal illness. It is Medicare’s most comprehensive benefit that is extremely helpful for terminally ill individuals and their families. Very few people are able to understand about Hospice care so this Medicare benefits often remain underutilized. Thus, people should have a good understanding of the Hospice care benefits so that they can avail of this benefit if the time comes. In 2021 CMS is bringing a pilot program that will allow Medicare Advantage plans to incorporate a hospice benefit. Participating insurers will allow beneficiaries of Medicare Advantage plan to receive hospice care through their existing insurance plan, with the similar coordination of care that they receive for other services.
Eligibility for Hospice Care
Hospice care benefit is not for everyone and only individuals who qualify for it are eligible to obtain this benefit of Medicare. Medicare beneficiaries will be eligible for this benefit in the following circumstances:
- Individuals having a life expectancy of fewer than six months are eligible for receiving hospice care benefits. Though, individuals living longer than six months can also continue to receive hospice benefits, if their hospice doctor recertifies that they are terminally ill.
- Individuals should agree to forgo further curative treatment options for their illness rather than opting for treatment that will keep them comfortable and maintain a good quality of life.
Medicare beneficiaries if choose a Medicare-certified hospice organization to receive hospice care, then nearly all of their costs will be covered.
What are the Benefits Covered under Medicare Hospice?
The Medicare hospice benefit covers all the care related to terminal illness and care that are necessary to keep individuals comfortable, as long as they receive care from a Medicare-approved hospice vendor. It covers all of the following benefits:
- Hospice physicians and nurses
- Essential medications that are required to keep patients comfortable and in control
- Home health aides to help patients in bathing and bed changes
- Social workers who help patients in getting things in order and to help them and their family deal with emotional stress
- Medical equipment like a hospital bed or a wheelchair essential to keep patients comfortable
- Respite care to provide the patient’s caregiver a break.
- If required dietician services.
- Grief counseling
- Inpatient admission if required for crisis management
- Any other services that the hospice team feels necessary to limit the symptoms of their terminal illness.
- Speech, occupational, or physical therapy required for the patient’s comfortability.
How Hospice Care Works?
The Medicare Hospice benefit is a part of Medicare Part A plan and when an individual signs up for hospice, then irrespective of whether they are on Original Medicare or Medicare Advantage plan, they will automatically be covered under the Original Medicare hospice benefit. If beneficiaries of Medicare Advantage plan require hospice care, then they can remain in that plan by paying their premium, and their Advantage plan will continue to cover their healthcare needs that are not related to their hospice needs or their terminal condition. Besides this, individuals also have the option to obtain care that is not related to their terminal illness through Original Medicare along with the regular deductibles and coinsurance applicable to that coverage.
Hospice care is only covered by Medicare if the hospice provider is Medicare-approved. Thus to find out whether a hospice provider is Medicare-approved or not, individuals can ask their doctor, the hospice provider, their state hospice organization, or their state health department. People who are on Medicare Advantage plan and wish to start hospice care can ask their plan to help find them a hospice provider in their area. An Individual’s plan helps them locate a Medicare-approved hospice provider of their area. If a person qualifies for hospice care, then he/she along with his/her family will work with the hospice team, to set up a plan of care that meets his/her needs.
Duration of Hospice Care
Hospice care is for people having a life expectancy of 6 months or less. However, if they live longer than 6 months, they can still get hospice care if the hospice doctor or medical director recertifies that they are terminally ill.
People can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods if their doctor or hospice doctor certifies at the start of each period that they are terminally ill.
You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
People also have the option to change their hospice provider once during each benefit period.