Financial Assistance for Hospice Care: Is Hospice Covered by Medicare?

Does Medicare Cover Hospice?

Medicare covers hospice care as long as the patients use a Medicare-supported program. You can browse Medicare-approved hospice providers within your respective areas using the online tool Medicare launched on its website. You can also consult your doctors, hospice providers, state hospice organizations, and health departments to ensure that Medicare can compensate for your chosen hospice program.

In 2019, the National Hospice and Palliative Care Organization reported that there were 1.61 million enrollees who received hospice Medicare benefits. Such a statistic marked an increase of 3.9 percent from the prior year. Those enrolled in the Medicare Advantage (MA) plans are found to utilize hospice benefits more as compared to regular Medicare users. MA enrollees who access hospice benefits grew from 51 percent in 2015 to 53.2 percent in the same year.

Medicare Qualifications for Hospice: Am I Eligible for Medicare Hospice Benefits?

To be a qualified recipient of Medicare hospice benefits, you must first ensure that you have Medicare Part A or Hospital Insurance. Moreover, you must fulfill the following conditions before being eligible to receive Medicare hospice benefits:

Hospice Care Coverage Requirements under Medicare

Medicare is comprised of four parts. Each component focuses on a distinct group of products and services. This section breaks down the different functions and coverage of each Medicare component in hospice care:

Medicare Part A

This component pays for patients’ hospital expenditures if they need to be hospitalized or taken to a care facility. This is also used to give your caregivers a chance to rest.

Medicare Part B

Part B accounts for all nursing and outpatient medical services, therapeutic services, and medical equipment used for the patient.

Medicare Part C

This division compensates for the treatments that are already unrelated and outside the patient’s terminal illness. It is also used to pay for services beyond those the original Medicare covers. Part C doesn’t play much of a role in hospice care because original Medicare already covers hospice expenses.

Medicare Part D

Similar to Part C, Part D mainly addresses payments for drugs and medications unrelated to a patient’s terminal illness. On the other hand, prescriptions and medications that aid in alleviating patients’ pain due to their terminal diseases are already included in the original Medicare hospice coverage.

Hospice Care Levels: What Does Medicare Pay for in Hospice?

Does Medicare pay for hospice? Medicare pays hospice facilities at a daily rate for every day that a patient benefits from the hospice program.

The daily payment rates account for the hospice’s expenditures according to the patient’s chosen care plans. A patient may choose any of the four levels of care below:

1. Routine Home Care:

Patients who are not in crisis typically prefer routine home care. This is because they can elect a day to receive hospice care rather than continuous home care. Despite what the name entails, routine home care is not exclusively within the patient’s private residence. It can also apply in skilled nursing facilities or assisted living facilities.

2. Continuous Home Care

If you have a loved one who requires immediate and consistent assistance, you might wonder if Medicare covers 24-hour hospice care. It can through this care level. The patient receives hospice care at home rather than in an inpatient facility.

3. Inpatient Respite Care

As the name indicates, the patient chooses to receive hospice care in a Medicare-approved inpatient facility within five consecutive days. This period gives the caregiver a chance to rest.

4. General Inpatient Care

The patient gets admitted to an inpatient facility to receive hospice care. This is intended explicitly for pain alleviation or acute or chronic symptom regulation which can be challenging to handle in other locations.

Hospice Care Covered by Medicare: What Are Hospice Medicare Benefits and Services?

Patients and families are guaranteed to benefit from the comprehensive variety of services that hospice caregivers have to offer. You should take note of these services and remember that patients are entitled to receive them in their overall plan of care as subsidized by Medicare.

Original Medicare will pay for a wide variety of hospice-related services, supplies, and medicines, including the following, if you are receiving care for an illness that qualifies you for hospice:

Duration of Medicare Hospice Coverage: How Long Will Medicare Pay for Hospice Care?

Hospice care is provided to patients diagnosed with a six-month or shorter life expectancy due to the current development of their condition. If the patient manages to live longer than six months, they can still receive Medicare hospice benefits so long as their doctors confirm the existence of their terminal illness.

Medicare offers an initial hospice benefit that runs in two 90-day benefit periods. As mentioned before, patients still in need of hospice care after six months can request recertifications from their doctors. Once their doctors validate their terminal illness, patients are entitled to an unlimited number of 60-day benefits.

It is crucial that you receive the optimal benefits of the Medicare hospice coverage as you are entitled to it. Hence, if you are ever displeased or unsatisfied with the service that your current hospice provider is giving you, you can switch to another hospice provider once throughout each benefit period.

Medicare—Bridging Hospice Care to More Patients and Families

So, does Medicare cover hospice? The answer is yes, and this has made hospice care all the more accessible to patients and families from all walks of life and socioeconomic backgrounds.

Medicare can at least partially cover almost all aspects of hospice care. You can rest easy and take comfort in the thought of receiving or giving your loved one the highest level of care while you still can.

To conclude, consider some of these points to make the most out of your Medicare benefits: