Discussing end-of-life care is challenging and uncomfortable, but it’s also important. Knowing what coverage you or your loved ones have through Medicare for hospice can give you peace of mind as you walk through a difficult season.
People have a lot of questions about Medicare coverage for hospice, including “What are the qualifications of someone to have Medicare cover hospice care?” and “Can Medicare deny hospice?”
This guide aims to answer these important questions so that you can approach an end-of-life situation with peace and security.
Hospice care is focused on making someone comfortable during their last days and weeks of life. These professionals provide compassionate care for both the patient and their loved ones during this difficult time.
Hospice professionals do not try to either hasten or delay the final passing, but instead treat the patient and their symptoms to maximize comfort. The focus is on providing dignity and high-quality time during the final days of life.
Care from a hospice is also family-centered, recognizing that the family members of the patient are also coping with a very difficult time. The patient and the family work with the care team to make health decisions as needed.
Hospice is one of the services covered under Medicare Part A in certain circumstances. In general, Medicare-approved hospice care happens either in the patient’s home or in another facility where the patient lives, like a nursing home.
If the patient has a Medicare Advantage plan, they still receive their hospice benefits through Original Medicare. Many seniors find that it makes sense to cancel their Advantage plan once they opt for hospice, although they will still need to cover their Part A and Part B premiums.
You’ll need to use a Medicare-approved hospice provider to get coverage. If you have an Advantage plan, that plan will help you find an approved provider. You can also find a Medicare-approved hospice team by talking to your doctor, hospice provider, or state health agencies.
Medicare will only deny hospice if the patient doesn’t qualify to have that type of care, or if they try to use a non-Medicare-approved hospice provider. For example, if your doctor believes you have more than six months to live, you won’t qualify for the Medicare hospice benefit.
If you feel that Medicare has unfairly denied your claim, you can file an appeal.
Understanding if you’re eligible for hospice benefits is the next question after you answer, “Is hospice covered by Medicare?”
You qualify for hospice care if you have Medicare Part A and:
Medicare will still provide coverage for treatment of Medicare-covered conditions not related to your terminal illness. For example, if you’re in hospice due to cancer, but got an infection, you could still get Medicare coverage to treat the infection.
Once a patient qualifies for hospice care, it’s important to find a qualified hospice team to treat them. Medicare has specific guidelines that allow a hospice provider to be Medicare-approved.
For example, the hospice has to provide all core services using employees and not contractors except in extraordinary circumstances. They also must offer medical social work services for the patient and their family, counseling, and bereavement services. A hospice must have nursing and medication available 24/7, offer specific additional services, and more.
These qualifications help assure the patient and their family that they are getting high-quality palliative care.
When a patient is in hospice, they have very few costs from Medicare. They need to pay the monthly premium to have Medicare Part A and B, and they may pay up to $5 per prescription for pain and symptom management.
If the patient gets respite care at an inpatient facility, there will be coinsurance of 5% of the Medicare-approved amount. Finally, the patient is responsible for room and board if hospice is given at their home or in another facility where they live, like a nursing home.
If a patient gets care outside of hospice care that’s related to the terminal illness, they will have to pay the full cost. For example, if a loved one is in hospice due to cancer and they go to the hospital for treatment related to that cancer, that treatment is not covered and the patient is responsible for the entire bill.
When you use Medicare Part A for an inpatient stay, there are specific limits on how long you can stay and what Medicare will cover. This leads many Medicare beneficiaries to wonder, how much does Medicare pay for a hospice per day?
Medicare does not have a per-day limit on hospice care. Instead, the focus is on stopping any attempt to cure the illness and instead making the patient comfortable.
Medicare hospice coverage will only cover services related to that goal. If you need treatment outside of that, for example for an illness or injury not related to your terminal illness, you’ll have the usual Medicare coverage along with deductibles, coinsurance, and copayments.
It can be challenging to face questions about end-of-life care, but it’s important to understand your Medicare benefits fully so that you or your loved one can use them appropriately.
If you have additional questions about Medicare and hospice, or you’d like help comparing Medicare plans to meet your needs, we’re here to help. Contact us today!
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