Hospice care under Medicare: Expenses, eligibility criteria, timeframe

Hospice care under Medicare: Expenses, eligibility criteria, timeframe

In the later stages of a terminal illness, hospice care can provide comfort and support to individuals and their families. This service, offered by Medicare, focuses on palliative care rather than actively trying to resolve the medical condition.

To be eligible for Medicare hospice care, certain criteria must be met. Firstly, the patient must be enrolled in Medicare Part A. Secondly, a doctor must certify that the patient has a terminal illness with a life expectancy of six months or less, based on the normal progression of the disease. This certification should be made after a face-to-face appointment. The patient must also sign a statement choosing hospice care (palliative or comfort care) instead of curative treatment for the terminal illness. Lastly, hospice care must be provided by a Medicare-approved hospice provider certified by Medicare and meeting federal standards.

Medicare hospice care is divided into benefit periods, starting with an initial 90-day period, followed by subsequent 90-day and 60-day periods if the patient's condition continues to meet eligibility criteria, with recertifications by the physician required at each interval.

Under Medicare, the cost of hospice-related services such as nursing care, medical equipment and supplies, counseling, and prescription drugs for symptom relief is largely covered. However, patients may incur some out-of-pocket expenses. For instance, there is a copayment of up to $5 per prescription drug used for pain relief or symptom management. For inpatient respite care (short-term inpatient care to relieve caregivers), patients pay 5% of the Medicare-approved cost. It is essential to note that Medicare does not cover room and board charges in assisted living or nursing facilities if hospice care is provided there.

Original Medicare (Part A and Part B) covers the cost of hospice care, with Medicare directly paying the healthcare professionals providing a person's hospice care. However, some associated costs apply, such as monthly premiums, copayments for prescription pain medications, and coinsurance for inpatient respite care.

Medicare Advantage plans may cover additional comfort or support medications or treatment that original Medicare does not cover. However, it is crucial to check with the specific plan to understand what is covered.

It is essential to remember that a person has the right to stop hospice care at any time. If a person's condition requires hospital treatment while in hospice care, the hospice organization must make the arrangements.

In conclusion, Medicare hospice care can significantly reduce hospital stays and emergency room visits for individuals nearing the end of their life. With minimal out-of-pocket expenses focused mostly on prescription copays and a small share for inpatient respite care, Medicare hospice care provides comfort and peace to people with terminal health conditions.

[1] Medicare.gov. (2021). Hospice Care. [online] Available at: https://www.medicare.gov/coverage/hospice-care

[2] National Institute on Aging. (2021). Hospice Care. [online] Available at: https://www.nia.nih.gov/health/hospice-care

[4] AARP. (2021). What Hospice Care Covers and What It Doesn't. [online] Available at: https://www.aarp.org/caregiving/end-of-life/info-2020/hospice-care-coverage.html

1. Hospice care is a service offered by Medicare, focusing on palliative care for individuals with a terminal illness.
2. To be eligible for Medicare hospice care, a patient must be enrolled in Medicare Part A and have a life expectancy of six months or less.
3. The patient's doctor must certify the terminal illness after a face-to-face appointment.
4. The patient must sign a statement choosing hospice care instead of curative treatment.
5. Hospice care must be provided by a Medicare-approved hospice provider.
6. Medicare hospice care is divided into benefit periods, with recertifications required at each interval.
7. The cost of hospice-related services, including nursing care and prescription drugs for symptom relief, is largely covered by Medicare.
8. Patients may incur out-of-pocket expenses, such as copayments for prescription pain medications and coinsurance for inpatient respite care.
9. There is a copayment of up to $5 per prescription drug used for pain relief or symptom management.
10. For inpatient respite care, patients pay 5% of the Medicare-approved cost.
11. Medicare does not cover room and board charges in assisted living or nursing facilities if hospice care is provided there.
12. Hospice-related services are directly paid by Medicare to the healthcare professionals providing the care.
13. Some associated costs apply, such as monthly premiums, copayments for prescription pain medications, and coinsurance for inpatient respite care.
14. Medicare Advantage plans may cover additional comfort or support medications or treatment that original Medicare does not cover.
15. It is essential to check with the specific plan to understand what is covered.
16. A person has the right to stop hospice care at any time.
17. If a person's condition requires hospital treatment while in hospice care, the hospice organization must make the arrangements.
18. Medicare hospice care can significantly reduce hospital stays and emergency room visits for individuals nearing the end of their life.
19. Medicare.gov provides information on hospice care.
20. The National Institute on Aging also offers information on hospice care.
21. AARP provides insights on what hospice care covers and what it doesn't.
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