Confused On How Medicare's Hospice Benefit Works?

By David Sayen

Choosing to enter hospice care can be a wrenching decision for yourself or a loved one.

Hospice is intended to help terminally-ill people live out their lives as comfortably as possible. Hospice doesn’t focus on curing disease and it’s not only for people with cancer.

Medicare’s hospice benefit covers your care, and you shouldn’t have to go outside of hospice to get care except in rare situations. Once you choose hospice, your hospice benefit should cover everything you need.

If you qualify for hospice care, you and your family will work with your hospice provider to set up a plan of care that meets your needs.

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You and your family members are the most important part of your medical team. Your team can also include doctors, nurses or nurse practitioners, social workers, physical and occupational therapists, speech-language pathologists, hospice aides, homemakers, and volunteers.

A hospice nurse and doctor are on-call 24 hours a day, 7 days a week to give you and your family support and care when you need it. You can also include your regular doctor or a nurse practitioner on your medical team, as the attending professional supervising your care.

The hospice benefit allows you and your family to stay together in the comfort of your home, unless you need care in an inpatient facility. If your hospice provider determines that you need inpatient care, your hospice provider will make the arrangements for your stay.

To find a hospice provider, talk to your doctor or call your state hospice organization.

The National Hospice and Palliative Care Organization has a website that allows you to look up local providers based on your zip code, at www.nhpco.org/find-hospice.

You can get hospice care if you have Medicare Part A (Hospital Insurance) and you meet these conditions:

■ Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less);

■ You accept palliative care (for comfort) instead of care to cure your illness;

■ You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

You have the right to stop hospice care at any time. If you choose to do so, you’ll go back to the type of Medicare coverage you had before you chose a hospice provider, like Original Medicare, a Medicare Advantage plan, or another type of Medicare health plan.

Your Medicare benefits include a one-time-only consultation with a hospice medical director or hospice doctor to discuss your care options and management of your pain and symptoms. You can get this consultation even if you decide not to get hospice care.

Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include doctor and nursing services; medical equipment (like wheelchairs and walkers); medical supplies (like bandages and catheters); prescription drugs; hospice aide and homemaker services; physical and occupational therapy; speech-language pathology services; social worker services; dietary counseling; grief and loss counseling for you and your family; short-term inpatient care (for pain and symptom management); and any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team.

If your usual caregiver, such as a family member, needs a rest, you also can get inpatient respite care in a Medicare-approved facility, like a hospice inpatient facility, hospital, or nursing home. Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care.

For more information on Medicare’s hospice benefit, including costs, please go to: https://www.medicare.gov/Pubs/pdf/02154.pdf.

Also see:

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David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

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