A guest blog by Danielle Kunkle
Danielle Kunkle is a co-founder of Boomer Benefits, a licensed Medicare insurance agency that helps baby boomers navigate their entry in Medicare in 47 states.
More information can be found on our Frequently Asked Questions pages on our site, or simply call us at 912.355.2289.
“America’s national health insurance program for people age 65 and older is Medicare. Medicare also covers people with certain disabilities or health conditions. While we often think of Medicare as a program that provides preventive care and coverage for doctor’s visits, Medicare actually covers many kinds of care. This includes end-of-life care for terminally ill individuals.
Eligibility for Medicare Hospice Care
You qualify for hospice care if you have Medicare Part A and a doctor certifies that you are terminally ill and have less than 6 months or live. (Also, this care is for any terminal illness and not just cancer.)
You must also be willing to accept palliative care (for your comfort) and forego aggressive treatment such as further surgeries, radiation or chemotherapies. At this time, you are entitled to a one-time consultation with a hospice doctor to talk about your options for care. Your doctor will then ask you sign a statement choosing to elect hospice
Medicare and Hospice Coverage
If you are enrolled in Medicare, you do not need to fear exorbitant bills for hospice care. Medicare’s hospice benefit is quite comprehensive.
Medicare Part A covers the majority of expenses related to your terminal illness. This is true even if you are enrolled in a Medicare Advantage plan instead of Original Medicare.
Once you’ve started hospice benefits, your care will be focused on comfort rather than on a cure. A big part of this care may be the provision of pain-relieving medications.
There may be a low copay of $5 or less for each prescription drug that is used to alleviate symptoms. However, if you are enrolled in a Medicare Supplement policy, it may cover your costs for these drugs. Some hospice centers may choose not to charge you this $5 copay either. It depends on the hospice.
It’s important to note that hospice care does not cover medications that are not related to the terminal diagnosis. You would continue to get any un-related medications through your Medicare Part D drug plan.
Hospice care can either be in your home or at a Medicare-approved facility. In-home respite care allows the caregiver and the terminally ill patient an opportunity to be comfortable in their own home. This avoids the potential stress of adjusting to a completely different environment.
In-home hospice care is generally provided by an interdisciplinary hospice team. Any necessary medical equipment will be brought to your home if that is the option that you choose.
It’s important to realize that hospice care is not just medical care. People on hospice will have an interdisciplinary team of professional and caring, doctors, nurses, counselors, social workers, and volunteers that provide the mental, emotional, social, spiritual and physical support a person needs for their end-of-life journey. These providers are always available around the clock by phone. You can reach them 24 hours a day, 7 days a week.
Family caregivers can get support as well.
Hospice Relief for Caregivers
In addition to palliative care for the patient, hospice benefits also provide a respite care benefit. This is not a benefit made available to ordinary Medicare beneficiaries – only to hospice patients. Medicare knows that caregivers face daily mental, emotional and physical challenges when assisting their loved ones during this difficult phase.
To qualify for occasional respite care, your caregiver’s break must be coordinated through a hospice provider at a Medicare-approved residential facility. This could be a nursing home or a hospice unit in your local hospital.
Each respite is for up to five days. As the Medicare beneficiary, you are responsible for no more than 5% of the cost of the Medicare-approved amount for each inpatient respite stay. Again, if you have a Medicare supplement, it will likely cover this coinsurance for you. Also, some hospice centers don’t charge this, so check with your hospice to find out what there policy is.
Recertification of Hospice
Patients electing hospice care must be re-certified at regular intervals by the hospice’s medical director. If your hospice benefit period expires, then the physician must review whether hospice care is still appropriate. This includes documentation and signatures that explain why clinical findings still show you to be terminally ill. Your care can continue as long as the physician can document that your prognosis is expected to be 6 months or less.
We are very lucky here in the United States to have a program like Medicare that provides this benefit to us. End-of-Life care involves a lot of different elements which is why it is so exceptional that Medicare uses a team approach to hospice care.
For assistance in finding a hospice facility, you can ask your doctor for recommendations or contact your state hospice organization. You can also reach Medicare at 1-800-MEDICARE to find Medicare-approved facilities in your area.”