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Navigating Hospice Care

End of life can be very scary and unnerving. However, hospice is a government funded program that exists to help. With a multi-disciplinary team approach, individuals can enjoy their final months instead of fretting over the details…and the bill.

When hospice care is needed:

When faced with end of life illnesses, hospice is there to help. Hospice is for individuals with six months or less to live. Rather than seeking a cure, hospice care aims to make and individual’s remaining time as comfortable and as meaningful as possible. This may mean pain relief and nursing care, but also includes emotional support and help with everyday tasks.

If you or a loved one is ready for hospice, but just not sure how to pay for it, you can find comfort in knowing Medicare covers most individuals who need these services. Read on for a break down who is eligible for Medicare, how much of hospice care it covers, and what options exist for those who require hospice but do not qualify.

Medicare Part A Eligibility:

Part A, also called Hospital Insurance, covers inpatient care, skilled nursing facility care, hospice care, and certain home health care costs. Medicare Part A specifically covers hospice care, but you must sign up for it. You can sign up for Medicare Part A when you are within 3 months of your 65th birthday, as long as you are not yet receiving social security benefits.

Some people are automatically eligible and enrolled in Medicare Part A, and therefore do not need to sign up. The criteria to be eligible for Part A automatically are:

  1. You are already receiving social security benefits.
  2. You are disabled and have received disability benefits for over 24 months.
  3. You have Amyotrophic Lateral Sclerosis (ALS) and receive social security benefits.

Ineligible for Medicare Part A:

Typically, the people who are not eligible for Medicare coverage under Part A are children and young adults with life-limiting illness. In these cases, the parents’ health insurance should cover the cost of hospice services. Young adults aged 18-35 with life-limiting illness are also not generally eligible for Medicare unless they qualify for social security benefits from the Americans with Disabilities Act (ADA). If you or your loved one are facing a life-limiting illness, qualify for hospice care, but are unsure of your Medicare eligibility, simply call 1-800-MEDICARE to speak with a representative to discuss your eligibility and options.

Medical Coverage & Criteria:

Your hospice care will be fully covered if you are eligible and enrolled in Medicare Part A. However, you will need to first have a hospice doctor, and your primary care physician (if you have one) certify that you are terminally ill – meaning you have a life expectancy of 6 months or less. If you’re already getting hospice care, a hospice doctor or nurse practitioner will need to see you about 6 months after your hospice care started to certify that your illness is still life limiting. Some people actually begin hospice care and later recover, no longer needing hospice. Prior coverage does not exclude you from receiving hospice care again. C

Hospice coverage includes:

  1. All items and services needed for pain relief and symptom management
  2. Medical, nursing, and social services
  3. Drugs
  4. Certain durable medical equipment
  5. Aide and homemaker services
  6. Other covered services, as well as services Medicare usually doesn’t cover, like spiritual and grief counseling

Medicare-Approved Hospice :

Sometimes an individual needs to spend time in a Medicare-approved location to facilitate their care. Hospice will only pay for a stay in a facility (room and board) if the hospice medical team determines that short-term inpatient care is needed for pain and symptom management that can’t be addressed at home. These stays must be in a Medicare-approved facility, like a hospice facility, hospital, or skilled nursing facility that contracts with the hospice. Medicare also covers inpatient respite care, which is care you get in a Medicare-approved facility so that your usual caregiver (family member or friend) can rest. You can stay up to 5 days each time you get respite care. Medicare will also pay for covered services for health problems that aren’t related to your terminal illness or related conditions. You can continue to get hospice care as long as the hospice medical director or hospice doctor re-certifies that you are terminally ill.

Out of Pocket Costs:

Hospice care is free to the patient. However, there are two costs associated with hospice that first must be paid by the individual. First, you must pay a copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it’s covered under Part D. You also must pay five percent of the Medicare-approved amount for inpatient respite care.

Who to Contact:

If you still have questions regarding coverage and eligibility for both hospice care and Medicare, it is helpful to contact a hospice provider in your area. They can help guide you through this difficult and unnerving process. Hospice providers have a deep understanding of how the Medicare system works. They will help you to find the care you need with the coverage you deserve. To connect with a hospice provider near you, simply call 1-800-HOSPICE.

 

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