Essential Things to Know About Medicare Hospice Benefits

As a loved one nears the end of their life, you’re certain to feel lots of strong emotions. You’ll likely feel grief and sadness, but many people also feel reassured knowing their loved one will no longer be in pain. One feeling families should never have to deal with is confusion, especially surrounding healthcare coverage. Understanding Medicare and how it covers hospice is essential for peace of mind as your loved one enters their final chapter. While every patient is different, here’s what you generally need to know about Medicare hospice benefits.

What Is the Medicare Hospice Benefit?

The Medicare hospice benefit is a specialized healthcare service covered under Medicare Part A that focuses on comfort care rather than curative treatment. This benefit provides comprehensive support for patients with terminal illnesses who have a life expectancy of six months or less if their condition runs its normal course. Unlike traditional medical care that aims to cure or treat diseases, hospice care emphasizes pain management, symptom relief, and emotional support for both patients and their families. The goal is to help patients live their remaining time as comfortably and meaningfully as possible.

Eligibility for the Medicare Hospice Benefit

To qualify for Medicare hospice benefits, patients must meet specific criteria. First, they must be enrolled in Medicare Part A, which covers hospital insurance. Most people automatically receive Part A when they turn 65 if they’re already receiving Social Security benefits.

After that, the primary requirement is a terminal diagnosis with a prognosis of six months or less if the illness follows its expected course. This diagnosis must be certified by that patient’s attending physician, but a wide variety of conditions can fall into this category. Patients with any of these ailments may be able to prove eligibility for the Medicare hospice benefit:

Advanced cancer
End-stage heart disease
Kidney failure
COPD – Chronic Obstructive Pulmonary Disease
Dementia

What Does Medicare Hospice Benefit Cover?

Medicare hospice benefits provide comprehensive coverage designed to address all aspects of end-of-life care. The benefit covers doctor services and as well as nursing. Medical social services are also covered to help patients and their families navigate the emotional and practical challenges during this time. Other covered services might include:

Home Medical Equipment—Medicare may pay for any equipment related to the terminal condition, including hospital beds, wheelchairs, and oxygen equipment.
Medications—Pain relief and symptom management medications should be covered by the Medicare hospice benefit.
Additional Therapies—Depending on the diagnosis, additional therapies like physical therapy, occupational therapy, speech therapy, and dietary counseling may be paid for under Medicare.

Limitations and What’s Not Covered

Unfortunately, Medicare does not cover every aspect of hospice care, and certain limitations and exclusions apply. For one, Medicare will not cover curative treatments for your terminal condition once you enter hospice care. Room and board charges aren’t generally covered either, which means many hospice patients benefit from choosing in-home care. However, Medicare may cover short-term inpatient care in a hospital or hospice facility when medically necessary for pain control or symptom management. In addition to these, the following services may not be covered:

Medication Unrelated to Illness—If your loved one wants to take prescription drugs unrelated to their terminal illness, they may not be covered under the hospice benefit. They may be covered under Medicare Part D if they have a prescription drug plan, however.
Transportation Costs—Transportation expenses, including ambulance services, are only covered when directly related to your hospice care and deemed medically necessary by your hospice team.
24-Hour Care—The Medicare hospice benefit does not typically cover continuous care for extended periods of time. It might, however, allow for short-term 24/7 care.

How Long Can My Loved One Receive Hospice Care?

In short, a person can receive Medicare hospice benefits for as long as their doctor certifies they have a life expectancy of six months or less. Nevertheless, doctors can’t tell the future, and if your loved one lives longer than expected, they can continue receiving hospice care as long as their prognosis has not changed. Talk to your loved one’s physician to learn more about their specific condition and how you should go about Medicare and hospice benefits.

Questions About Hospice? Reach Out to Us

Understanding Medicare hospice benefits is just one part of end-of-life planning. If a loved one is facing a terminal illness, it might be time to discuss hospice with their healthcare provider. Should you have any questions along the way, Agape Hospice NW is here to help. We’re a trusted hospice provider in Portland, OR, and we would be honored to serve your family during this challenging time. Contact us today for more information.

Frequently Asked Questions

Can I change hospice providers if I’m not satisfied with their care?

Yes, you can change hospice providers at any time during the benefit period without losing out on Medicare hospice benefits.

What happens if my loved one lives longer than six months while receiving hospice care?

Patients can continue receiving hospice care as long as their doctor and the hospice medical director certify that they remain terminally ill. There’s no limit to how long someone can receive hospice benefits if they continue to meet eligibility requirements.

Can a patient still see their regular doctor while receiving hospice care?

Yes, your loved one can continue seeing their attending physician, and Medicare will cover their services. However, all care must be coordinated through the hospice team to ensure it aligns with comfort care goals.

What if my loved one wants to try curative treatment again?

Patients can revoke their hospice election at any time and return to traditional Medicare coverage. This allows them to pursue curative treatment like before. They can always re-enroll in hospice benefits later if necessary.