End-of-life hospice care is a difficult subject for anyone to undertake, especially when considering the financial aspects. For those relying on Medicare, understanding how long Medicare will pay for hospice care is crucial. Here, we’ll delve into the key points to know about Medicare’s hospice benefit, helping you make informed decisions for your loved one. For more personalized assistance, please speak with a ClearBenefits agent today.
Who Qualifies for Hospice with Medicare?
Hospice care is designed to provide comfort to patients with terminal illnesses. To qualify for the Medicare hospice benefit under Part A (hospital insurance), the following conditions must be met:
- The patient must be diagnosed with a terminal illness by their primary care provider or hospice doctor, with a prognosis of six months or less.
- The patient must accept palliative care instead of treatment aimed at curing the illness.
- While entering hospice care is a significant decision, patients retain the right to opt-out of hospice care and seek curative treatment if they choose to do so.
Medical Conditions That Qualify for Hospice
This list is not comprehensive. If a loved one does not have one of the following conditions, but they’ve received a prognosis of less than 6 months, consider speaking to their healthcare provider about receiving hospice.
- Cancer
- Liver disease
- Stroke
- AIDS
- Congestive heart failure
- Diabetes
- Heart valve disorders
- End-Stage Renal Disease
- Parkinson’s Disease
- Huntington’s Disease
- Multiple Sclerosis
- Dementia
What Medicare Will Pay for During Hospice
Medicare’s hospice coverage is designed to alleviate the financial burden during this challenging time. Medicare covers a range of services, including:
- Doctor services
- Nursing care
- Prescription medications for symptom control and pain relief
- Medical equipment (e.g., wheelchairs, walkers)
- Medical supplies (e.g., bandages, catheters)
- Hospice aides and homemaker services
- Physical therapy, occupational therapy, and speech-language pathology
- Social worker services
- Dietary counseling
- Grief and loss counseling for both the patient and family
- Short-term inpatient care for pain and symptom management
- Short-term respite care
- Additional services necessary for managing symptoms as determined by the hospice team
Gaps in Medicare hospice coverage
While Medicare’s hospice benefit is comprehensive, it does have limitations. Medicare will not cover:
- Room and board if the patient receives care at home, in a nursing home, or a hospice inpatient facility (except for short-term respite or inpatient care).
- Treatment or medications aimed at curing the terminal illness and related conditions.
- Care provided by a provider not arranged by the patient’s hospice team.
- Outpatient, inpatient, or ambulance services not coordinated by the hospice team.
Ensuring that care is coordinated through the hospice team is essential for maximizing Medicare coverage and avoiding unexpected costs.
How long will Medicare pay for hospice care?
Hospice care under Medicare is intended for six months, divided into two 90-day benefit periods. During these periods, the patient’s primary hospice doctor or primary doctor must recertify that they are terminally ill. If a patient outlives their initial prognosis, hospice care can continue indefinitely in subsequent 60-day benefit periods, with the doctor recertifying the terminal illness at the end of each period.
Conclusion
Understanding the nuances of hospice care costs and the Medicare hospice benefit is crucial for providing the best care for your loved ones. At ClearBenefits, we specialize in answering all your Medicare questions, ensuring you understand every aspect of your coverage. Our commitment to 100% accurate quoting means you’ll always know exactly what you’re getting before you sign up. Contact a ClearBenefits agent today to learn more about how we can assist you with all your Medicare needs, no matter the time of year.