The Medicare program will provide covered benefits for Hospice Care. That is palliative (comfort) care, rather than treatment designed to cure a disease. Coverage is available in the home, in a hospice facility, and in some circumstances in nursing facilities. Hospice care focuses on holistic, comfort care, including family counseling, which can be a meaningful alternative when faced with a terminal illness.
A beneficiary enrolled in Medicare Part A is entitled to 90 days of hospice care, with subsequent periods that can continue for quite a while, as long as the patient’s doctor and the hospice director certify that the beneficiary is terminally ill. Initially they must both provide the certification, but subsequent periods of coverage can be based on one or the other’s certification. Terminally ill means that the doctor believes a similarly situated patient would have six months or less to live, if the illness runs its normal course. Even if the beneficiary does not die within six months, the coverage can continue for as long as necessary.
By electing hospice treatment the Medicare beneficiary waives any right to curative treatment for the terminal illness. That means that Medicare will not pay for treatment that is designed to cure the particular illness that is expected to cause death. Medicare will still cover treatments for other medical conditions, if necessary. The patient can also elect to revoke the choice of hospice care and resume eligibility for curative treatment for the terminal illness.
In order for Medicare to cover the hospice services they must be provided by a Medicare certified hospice provider. These providers must have an interdisciplinary team of doctors, nurses, social workers, and chaplains or other counselors. Each patient must have a written care plan that describes the services the patient receives and how those services will be provided and supervised.
Medicare covers hospice services including medical and nursing services, counseling services provided to the terminally ill patient and the close family, short-term inpatient care, respite care, continuous home care for crisis periods, bereavement counseling, medical appliances and supplies, home health aide services, homemaker services, physical therapy, and other therapies designed to maintain the activities of daily living and functional skills of the patient.
Some of these same benefits are available under state Medicaid programs for those individuals who are not eligible for Medicare coverage and who qualify for Medicaid benefits. The rules differ for Medicaid, and the benefits are sometimes limited to a period of 210 days. A similar certification that the patient is not expected to live more than six months is required.
Sometimes medical personnel are not aware of the benefits available under the Hospice program. Sometimes doctors refuse to recertify a patient who does not die within six months, even though they are still expected to die. Patients and their families, who want Hospice care, must advocate for the benefits and ensure that the care is given when needed. The family must work closely with the hospice providers to ensure that enough quality services are provided to the patient.
If you have any questions about eligibility or what hospice care entails, ask your doctor, your health care facility, call your local Medicare office, or contact a your Elder Law Attorney.