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Does Medicare Cover All Hospice Care?

Just the essentials...

  • Hospice care is a Medicare Part A covered program to assist those certified to have a terminal illness with less than 6 months to live

  • You can receive hospice care while at home, in a nursing home, or assisted living facility

  • Medicare Part A will cover doctors, nurses, home health aides, housekeepers, medications and all treatments to manage pain or control symptoms that the treatment team deems medically necessary

  • Maintain frequent, clear communication with your hospice treatment team because Medicare will not cover any treatments or supplies that are not authorized as needed by the attending physician

  • Hospice care is at no charge for those with Medicare Part A and certified terminally ill, but there will be a minimal copay for prescriptions and respite care

  • Find a Medicare assigned hospice service that is licensed, insured and has a record of taking good care of patients and families

Does Medicare cover all hospice care?

Hospice care is a service covered by Medicare Part A, but to receive it you have to have a qualifying terminal illness with a life expectancy of six months or less.

The focus of hospice is to make terminally ill patients as comfortable, symptom-free and pain-free as possible in their final months of life.

Medicare will pay the largest portion of the bill, but there are some specifics to watch out for so that you or family are not left with high medical bills.

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What is Hospice Care?

Does Medicare cover all hospice care?

When you or a family member is facing a terminal illness and your doctor has stated that you have six months or less to live it is time to begin preparations for hospice care.

This type of care involves a team of treatment professionals, normally headed by a hospice doctor, that is in place to make you as comfortable and pain free as possible during your last months of life.

It is essential to choose a hospice agency that is Medicare-approved, otherwise Medicare will not pay.

Treatment is no longer focused on cure, but how to make pain levels tolerable and symptoms less severe.

How to Qualify for Hospice Care

There are certain conditions that have to be met in order to qualify for hospice care with a Medicare provider. These are:

  • You MUST have Medicare Part A
  • You have to be certified by the hospice doctor or a private physician to be terminally ill with less than 6 months to live
  • You MUST agree to palliative (comfort) care only, rather than treatments for a cure
  • You have to sign documentation that you wish to seek hospice care instead of traditional Medicare covered treatment options

Hospice Care Where You Live

Hospice care is designed to allow you to spend your last remaining months at home or at the home of another loved one so that you are as comfortable as possible. It gives families the privacy and time needed to come to grips with the reality of the medical situation.

Medicare hospice care providers will be on-call 24 hours a day, 7 days a week to answer any questions and handle any emergency situations that arise.

In-Patient Hospice Care

There may be times that it is medically necessary to enter a hospital or hospice care facility for pain management or to deal with excessive symptoms in regards to the terminal illness.

Medicare will cover the in-patient treatment as long as it is deemed necessary by the hospice or private physician to be in your best interest.

You will only be offered stabilizing and palliative care to control pain or symptoms.

What Will Medicare Part A Cover?

There are a lot of different services that Medicare will cover when it comes to hospice care.

The magnitude of the responsibility of caring for someone with a terminal illness is why it requires a team of people to get things done correctly.

Medicare Part A will cover:

  • Doctor
  • Nurses
  • Medical equipment and supplies
  • Prescription drugs (for pain and symptoms rather than cure)
  • Hospice aide and housekeeping
  • Physical and occupational therapist
  • Speech pathologist
  • Social worker
  • Diet and nutrition aide
  • Grief and loss counseling (for patient and family)
  • Short-term in-patient or respite care
  • Other Medicare covered services and supplies the hospice team determines are necessary.

Allowed Treatments

Hospice treatment and medication will revolve around making you as comfortable and as mobile as possible, while managing  pain and symptoms.

Qualifying and receiving hospice treatment covered by Medicare means you have to agreed to give up fighting to cure a terminal illness and the allowable treatments and medications will reflect that decision.

A few things that Medicare will NOT cover during hospice care are:

  • Treatments to cure terminal illness
  • Medications to cure terminal illness
  • Surgeries or procedures to cure illness
  • Anything not pre-approved by hospice team

Pain Management and Comfort

Does Medicare cover all hospice care?

Every member of the hospice treatment team is highly focused on making the patient as comfortable and symptom-free as possible and keep any pain to a minimum.

Family, nurses and hospice aides all help assist the doctor in knowing when pain is severe and symptoms have gotten worse.

Emergencies may require changes in medication or short stays in-patient for respite care to get the situation under control.

The primary ideal during hospice is that the patient be allowed to stay at home, in familiar surroundings with the people they love.

Care Outside of the Hospice Treatment Team

Does Medicare cover all hospice care?

Medicare Part A will only cover the costs of hospice care if you are qualified and work within the advice and demands of the hospice treatment team.

You will be fully responsible to pay for any treatment sought outside of your hospice team for the terminal illness.

Original Medicare will not cover any treatments, procedures or emergency room visits that pertain to the terminal illness when they are not deemed necessary by your hospice team.

However, you can seek treatment or medical advice for problems that are unrelated to the terminal illness.

In these cases, Original Medicare will pay as it did before opting to utilize hospice services.

Communicating With the Hospice Treatment Team

The best way to avoid unnecessary bills and misunderstandings when in hospice care is to communicate well with the designated hospice treatment team.

Make them aware of any additional health problems and let them know when:

  • You need to seek emergency medical treatment.
  • You are about to run out of medication.
  • An additional medical problem needs attention.

If you do not make the hospice staff aware that you might need emergency treatment, then you may be forced to pay for the ambulance, emergency room, doctor and any additional medications.

This can very quickly amount to large expenses.

You have the ability to opt out of hospice care and go back to getting treatments to combat the illness at any time.

Discuss this with the treatment team doctor and let them know how you are feeling.

How much does hospice care cost?

Does Medicare cover all hospice care?

If you are covered by Medicare Part A, have been diagnosed with a terminal illness and given 6 months or less to live, then hospice care will not cost anything.

You will have to pay a $5 copay for prescriptions and other medical supplies and a 5 percent copay for any in-patient respite services.

Everything else the approved hospice team provides will be covered by Medicare.

How long does hospice care last?

Does Medicare cover all hospice care?

The certification to use hospice care is scheduled in small periods of time. You first get two consecutive 90-day periods, but you can then have an unending number of 60-day periods.

Each time Hospice care is extended, the qualifying doctor has to certify that you are terminally ill with 6 months or less to live.

You can opt to leave hospice care at any time and return as long as you still qualify under your doctor’s assessment. It gives you flexibility in case the illness begins going into remission.

Finding a Hospice Care Provider

Does Medicare cover all hospice care?

Hospice care by a professional team of healthcare experts is one of the most compassionate services available.

Nonetheless, long-term and hospice care are choices that no loved one wants to make for you and can be difficult to make on your own.

Once you have decided that hospice care might be the right option, it is essential to make sure the service you use is of high quality.

You need to find out:

  • Are they licensed and insured?
  • Do they respond well after hours?
  • Are the aides trained to work in your home?
  • Are they Medicare assigned?

If staying at home is becoming too difficult, there are alternative solutions that will allow daily assistance in care along with receiving the hospice service to help you through the last months.

Medicare Part A is incredibly generous in the amount of coverage it will extend to those that are facing a terminal illness with little chance of long-term survival.

If you or a loved one are facing this challenge it might be time to see if you qualify for hospice services today.

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