When Does Medicare Cover Hospice?

 In Advice, Insurance, Medicare

When navigating the complexities of end-of-life care, cost can be a burden to many families. Many individuals often find themselves asking, “Does Medicare cover hospice?” The reassuring answer is that Medicare does pay for hospice care, providing significant financial relief during this challenging time. However, it’s important to note that Medicare doesn’t cover everything, and there are some services that might not be included.

A lot of people who qualify for Medicare hospice care don’t know that they’re eligible. Many often struggle to access other means of payment. Facing hospice care is hard. It shouldn’t be the time to be anxious over finances.

We have made Medicare coverage for hospice more understandable; now you can easily determine if you or a family member qualifies.

Qualify for Medicare hospice benefits

The beneficiary is entitled to Medicare Part A, which is hospital insurance. The US Federal Government provides Medicare Part A health insurance to all U.S. citizens; it’s also available for legal immigrants who’ve lived in the U.S for at least 5 years.

Medicare Part A covers inpatient care services. To qualify you must have a life expectancy of six months or less if the illness runs its course.

However, because diagnoses are not always exact, living longer than six months will not automatically void the beneficiary’s cover.

Each beneficiary gets an infinite number of supplementary 60-day periods after the first period; so, you can go years on the hospice benefit if the physician believes your expectancy is six months or less.

Only the hospice doctor or the beneficiary’s regular doctor can legally certify as to the terminal illness of the beneficiary.

The beneficiary must sign a statement selecting the hospice benefit; this means foregoing any treatment to cure the illness and electing to receive only palliative care.

This means no cutting-edge tests, and no experimental drugs meant to cure the disease. Under the Medicare Hospice benefits, care is to provide relief from the symptoms and stress of the disease. Palliative care is there to address the physical, intellectual, emotional, spiritual, and social needs of the patient and his family.

If the beneficiary already lives in a nursing home, Medicare won’t pay for room and board; however, they pay for care for the terminal illness. This is often a long process because the nursing home and the hospice providing the care need to sign a contract as to who is responsible for what.

To qualify for Medicare hospice benefits, the beneficiary must be willing to receive care from a Medicare-approved hospice provider, and not a privately-run hospice provider.

Hospice Services Medicare Covers

Medicare hospice benefits help not only the patient but family members as well. Thus, the services that it does cover are wide and extensive.

Whether in full or partly, Medicare hospice benefit covers doctor services, nursing care, prescription drugs for pain relief, medical equipment such as walkers and wheelchairs, and physical and occupational therapy services, if needed.

Other services that Medicare pays for as per hospice care are dietary counseling, medical supplies, and hospice aide services.

Medicare hospice benefits cover social work services, short-term inpatient respite care, and short-term inpatient care to manage pain. Also, Medicare covers grief loss counseling for both the patient and their family.

Hospice Services Medicare Won’t Cover

Knowing what Medicare won’t pay for when it comes to hospice care is important. These benefits Medicare won’t cover under its hospice benefits. Medicare won’t pay for room and board in nursing homes, inpatient hospice houses or assisted living facilities.

If you’re thinking about treatment to cure illness rather than continue with palliative care, discuss this with your doctor. This treatment will mean an end to Medicare’s hospice coverage. Medicare doesn’t cover prescription drugs; except when for pain relief and symptom control in the hospital or outpatient facility.

Medicare won’t pay for care from a provider that wasn’t set up by the hospice medical team. As a matter of policy, your care must always be given by your chosen hospice provider.

Medicare won’t pay for the care unless the hospice team arranges this, or it’s not related to your terminal illness.

If you need a hospital’s inpatient for your terminal illness the hospice provider must make the arrangements. Going to the hospital when the hospice provider didn’t plan means being personally responsible for the entire cost.

The Denver Hospice offers different levels of hospice care.

Contact us for more information!

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