Does Medicare Cover Hospice?
Hospice in Portland, OR
Choosing to pursue hospice care for yourself or a loved one is a challenging and emotionally charged decision that can be overwhelming to navigate on your own. One of the main factors families will look at is how much this type of care will cost and whether or not hospice care is covered under Medicare.
Hospice care is covered by Medicare. However, there are certain requirements and conditions for this type of coverage that patients and families should familiarize themselves with prior to commencing hospice care treatment.
Understanding Hospice Care
Hospice care is designed to keep a person comfortable during their final stages of life, enabling them to have dignity and support. Hospice care eliminates curative treatment plans and instead guides the patient with support and services that help them maintain quality of life during their last months of life.
Medicare Hospice Coverage Requirements
In order to pursue coverage for hospice care through Medicare, a patient must meet the following requirements:
- The patient has Medicare Part A, hospital insurance.
- The patient’s doctor and hospice medical director have certified the patient as terminally ill with a life expectancy of six months or less.
- The patient or their legal guardian has elected palliative care, terminating Medicare-covered benefits used as a curative treatment, and they have signed to confirm the transition.
- The hospice care will be provided by a Medicare-approved hospice service.
Hospice Services Covered By Medicare
Medicare covers hospice care services and resources for both the patient and their loved ones. Some services may be covered in full, while others may be covered in part by Medicare. These services include:
- Doctor and nursing medical attention
- Counseling services
- Medical equipment and supplies
- Prescription pain relief or symptom control drugs
- Dietary guidance
- Practical assistance services
- Physical and occupational therapy
- Short-term inpatient respite care
- Other Medicare-covered services recommended by the hospice care team
Medicare and Hospice for Dementia Patients
Medicare typically covers hospice care services for dementia patients. However, they must meet the following criteria:
– Their dementia is beyond stage 7, meaning they struggle with walking, dressing, bathing, urinary or fecal incontinence, or limited verbal communication.
– They have another illness or comorbidity alongside their dementia, such as pressure ulcers, pneumonia, and severe weight loss, and they have been treated for this within the last year.
Respite Care Coverage
As the primary caregiver of a person who is terminally ill, it’s normal to feel emotionally or physically drained, as you spend the majority of your time tending to the needs of your loved one. To assist with this selfless act, Medicare offers coverage for respite care.
Respite care involves having a Medicare-approved nursing care facility that can admit your loved one while continuing to receive our hospice services at the new facility. Agape Hospice NW goes wherever the patient goes.
With the addition of the new temporary facility, the patients loved ones can have time to go home, rest, or focus on themselves for a period of one to five days, knowing that their loved one is in good hands.
Medicare and 24-Hour Hospice Care
Medicare Part A offers coverage for 24-hour hospice care. Typically, 24-hour care is a rare occurrence that is only needed in emergency cases that deal with end-of-life symptoms. However, Medicare Part A is hospital care, meaning that a patient cannot obtain coverage if they need 24-hour in-home care.
What Is Not Covered By Hospice
Although Medicare beneficiaries qualify for a number of hospice services, the following will not be recognized or covered by hospice.
- Treatment to Cure a Terminal Illness. If a patient decides to pursue a curative treatment, their hospice care coverage will be revoked through Medicare. Patients are entitled to withdraw at any time if they feel a curative treatment is in their best interest, and if they decide to resume hospice care, they will be able to reclaim Medicare coverage.
- Prescription Drugs to Cure a Terminal Illness. As hospice care is not designed to be a cure or treatment plan for a patient’s illness, any prescription drugs used with the intent to cure the patient’s illness will not be covered by Hospice. Hospice will only cover drugs used for pain relief and symptom management and any and all drugs related to the admitting diagnosis.
- Outsider Care. A patient cannot pursue outsider hospice care once they have chosen their hospice team unless they are willing to change their selected Medicare-approved provider through Medicare. A patient may still visit their primary physician or nurse practitioner if they are a part of overseeing the patient’s hospice care.
- Room and Board. Medicaid can cover room and board for hospice patients if the patient is choosing to reside in a nursing facility. Agape Hospice NW can assist in helping the patient and their loved ones in finding a Medicare and Medicaid approved facility where the patient can receive care from Agape Hospice NW as well as the facility.
- Emergency Care. If during a patient’s hospice care, they require emergency intervention, such as transportation by ambulance or care or treatment in an emergency room or hospital, it may not be covered by the hospice benefit. This is why it is very important to always contact Agape Hospice NW 24/7 for any emergencies before calling 911.
Learn More About Hospice Care
At Agape Hospice NW, we are honored to offer nurturing hospice services to eligible individuals in need of support. Our team of experts is dedicated to providing compassionate, respectful, and dignified care and support to our patients and their loved ones during the end-of-life journey. Contact our caring team today to learn more about our hospice care services.