Does Medicare Cover Hospice
If you’re a Medicare beneficiary, Medicare does cover hospice. Medicare beneficiaries might not know about the hospice benefit that’s available to support end-of-life issues.
Dealing with a terminal illness is extremely challenging for the patient and his or her loved ones. Worries about care-giving, pain management, and costs of medication are overwhelming.
Financial planners say that Medicare hospice benefits are underused by beneficiaries. Hospice care can help the dying patient with medical care, emotional support, and pain management per his or her wishes.
For qualifying patients, Medicare pays for comprehensive hospice care delivered in a hospice facility or in the patient’s home. Importantly, Medicare Part F supplement plans cover patient deductibles and co-pays for Medicare eligible hospice beneficiaries.
Medicare Hospice Benefit
The hospice benefit includes an array of services that aren’t typically covered by Medicare. CMS says that approximately 90 percent of hospices across the nation are Medicare-certified. The Medicare hospice benefit includes:
- Doctor and nurse practitioner (NP) services
- Medical supplies and appliances
- Short-term respite care and in-patient care
- Nursing care
- Home health aide (CNA) and homemaker services
- Social worker services and counseling services
- Spiritual support
- Bereavement services
Medicare Pays for the Hospice Patient’s Comfort, Not Cure
Hospice care is aimed at making the patient more comfortable. Items like chemotherapy and physical, speech, and occupational therapy may be paid for by Medicare if they provide comfort or palliative care.
Medicare won’t pay for therapies that are intended to cure the patient in a hospice setting. A Medicare Part F supplement plan can help terminally ill patients and their families to absorb end-of-life care costs.
Medicare Hospice Services
If the Medicare beneficiary isn’t already in hospice, Medicare will pay for the patient to receive a consult with a hospice physician. The consultation may occur at home, in hospital, or nursing facility.
The hospice physician will perform a pain assessment and help the patient and his or her family to consider care options.
The Medicare hospice benefit can help the patient to save money at a time when he or she shouldn’t have to worry about high costs of pain medicines.
When the beneficiary elects the Medicare hospice benefit, medicines related to his or her terminal illness may be covered under Medicare Part A. A Medicare supplement plan covers the patient’s copay or deductible for Medicare-eligible services as well.
Medigap Supplement Plan F
A Medigap Part F supplement plan covers costs that exceed the coverage limits of Medicare, including:
- Hospital stays. Medicare Part A covers a limited amount of the patient’s hospital stay expenses. Medigap Plan F covers hospital costs for 365 days after the beneficiary’s Part A coverage is maxed out.
- Medicare co-insurance. Medicare Part B requires the policyholder to pay a 20 percent co-insurance amount. A Medigap Plan F supplement covers co-payments for services approved by Medicare.
- Medicare hospice benefits. Medicare Part A requires the patient to make co-pays for his or her hospice care. A Medigap Plan F supplement covers these co-payments.
- The Medigap Plan F supplement adds coverage to Medicare Parts A and B. It goes beyond merely paying for deductibles and co-pays that original Medicare doesn’t, including:
- Nursing care. Costs of skilled nursing facility services are covered by Medigap Plan F.
- Travel insurance. If the patient is traveling outside of the U.S., his or her basic medical and health care needs are covered in an emergency.
- Additional charges. Fees that exceed the Medicare Part B cap are covered.
- Medicare Part A. The Medigap Plan F supplement covers the patient’s deductible for hospital services.
- Medicare Part B. A Medigap Plan F also covers the deductibles for outpatient services.
- Medicare Hospice Eligibility
- If you are an original Medicare beneficiary and you’re entitled to receive Medicare Part A, you may receive hospice benefits after a physician certifies that your life expectancy is six months of less (if the illness runs an expected course). If you live longer than six months, you don’t lose the Medicare hospice benefit:
- After the first certification period, the beneficiary is provided with an unlimited amount of 60-day certification periods.
- The hospice patient may live for years using the Medicare hospice benefit if the physician or facility medical director believes that the patient is terminally ill and has a life expectancy of less than six months.
- To elect the hospice benefit, the Medicare beneficiaries signs a statement of requesting it if he or she has the capacity to do so. In this action, the patient agrees to forego curative treatments. Instead, he or she wants to make the end-of-life experience more comfortable.
Fortunately, the patient isn’t locked into hospice benefits after electing them. He or she may revoke the hospice benefit and re-elect it later—as many times as is necessary.
The hospice patient doesn’t need to stay homebound. He or she doesn’t have to have an advance directive or DNR order in place to elect hospice benefits.
The beneficiary can keep his or her doctor or NP, as Medicare believes there’s potential value in an independent medical provider’s oversight of the patient in hospice.
Medicare Hospice for Nursing Home Residents
If the Medicare beneficiary is already a nursing home resident, the hospice benefit doesn’t cover the costs of his or her nursing home room and board.
However, if his or her Medicaid or another insurer pays for the cost of the nursing home, Medicare typically pays for hospice care. The hospice and nursing home must sign a contract that describes respective responsibilities to the Medicare beneficiary.
Many people believe that hospice care is only electable in the last few days of life. CMS reports that the average beneficiary stays less than a month in hospice before death.
As you can see, it’s possible to get the hospice care you or a loved one needs for longer periods when necessary. Along with Original Medicare, a Medigap Supplement Plan F can help pay for compassionate care.
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