The Medicare Hospice BenefitThe Medicare Hospice Benefit

Deciding to go into hospice care can be a difficult time for you and your family.  It is a decision that requires careful consideration and discussion with your loved one, their doctor, and family members. Medicare offers hospice care if you decide that this is what is right for your loved one.  Here are four important questions to ask about Medicare hospice benefits so that you can make an informed decision.

What Is Hospice Care?

When a patient has a terminal illness, hospice care is a team-oriented approach to medical care, pain management, and emotional support that is tailored to the patient’s needs.  The main focus of hospice care is not to cure a patient’s illness but provide quality care to make sure that they are comfortable.  Hospice is usually administered in a person’s home but can be given in an inpatient facility like a nursing home.  A hospice care team usually includes the primary doctor, the hospice doctor, nurses, social workers, clergymen, and sometimes volunteers.  This team will take care of the patient and administer drugs to manage pain and symptoms, offer support about accepting the end of life, counsel the patient’s family about dying, and make sure the patient’s last wishes are met.

Who Is Eligible For Hospice Under Medicare?

If you have Medicare Part A, then you might be able to have your hospice care paid for partially or in full.  You must also meet three other criteria:

  • Your doctor must confirm that you have a terminal illness with a life expectancy of fewer than six months;
  • You accept palliative care instead of medical care to cure your illness; and
  • You sign a statement that says you have chosen hospice care instead of any other medical treatment care that Medicare covers for your illness.

It is important to note that only your doctor can confirm and certify that you have a terminal illness and sign off on hospice care.  Make sure that you talk with your doctor to discuss all options about your illness so that you can make an informed decision about hospice care.

What Will Medicare Cover?

Under Medicare, you are allowed to get one hospice consultation with either a hospice director or hospice doctor. You will be able to discuss all your options when it comes to your illness, including pain management and symptoms. Medicare will cover this consultation even if you decide that you do not want hospice care.  If you do decide that you would like hospice care, Medicare will cover all the costs of your hospice care as long as they are related to your terminal illness.  You need to make sure the care you choose is from a Medicare-approved hospice program.  You can call Medicare to find a hospice program near you that is approved.

What Won’t Medicare Cover?

There are a few things that Medicare won’t cover under hospice care.  These include:

  • Prescription drugs, unless they are for symptom control or pain relief
  • Treatment to cure your illness
  • Care from a provider that was not set up by your hospice team
  • Room and board, unless your hospice team decides you need short in-patient care
  • Care in an emergency room, inpatient facility, or ambulance unless it is arranged by hospice

All treatments that you had to try and cure or treat your illness before hospice care will also no longer be covered under Medicare.

Hospice care is a big and life changing decision.  You need to make sure that you have all information possible before you choose to go into hospice.  Your loved one’s doctor and other caregivers can help guide you to the choice that is best for you and your family.  Make sure to ask these important questions and if you need further information you can visit Medicare.gov.

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