Hospice can be an underutilized and misunderstood Medicare benefit for people at the end of life. In some cases, families may be reluctant to start hospice care because it is an emotional decision. It is hard for anyone to see their loved ones in pain and face the realization that they are dying.
Jump ahead to these sections:
- Will Medicare Pay for Hospice?
- What Are the Medicare Hospice Benefits for this Year?
- How Long Will Medicare Pay for Hospice?
There is also the misconception that somehow hospice hastens death. The reality is that hospice makes people comfortable while they are dying. The kinds of comfort care provided through hospice involves managing pain and bodily discomforts. They help with small things like cracked lips and dry skin, but also spiritual counsel, music therapy, and much more.
Most people start hospice too late and may wish they had started sooner once they see the benefits. They wait, and then hospice can only offer their services for a short time before the person dies. As hospice is a flexible benefit, there are few downsides to starting this kind of care soon as you can. Knowing what is covered by Medicare when choosing hospice can help with making this decision.
Will Medicare Pay for Hospice?
Medicare pays for hospice care as long as you meet their hospice criteria, and the hospice provider you choose is Medicare-approved. For Medicare to cover hospice services, a physician must certify that you or your loved one has six months to live.
Most people think that hospice can only be used for a terminal cancer diagnosis, but other terminal conditions qualify someone for hospice as well. It can include the following:
- End-stage Alzheimer’s or other types of dementia
- Heart failure
- Lung disease
- Kidney disease
- Neurological disorders like Parkinson’s, ALS, or Multiple Sclerosis
- Liver disease
- Heart disease
- Human Immunodeficiency Virus (HIV)
If you are on a Medicare Advantage plan, you may have some concerns about coverage since these plans sometimes restrict the health providers you can go to. Once you are approved to go on hospice, original Medicare pays for all of your hospice care. That being the case, you can choose any Medicare-approved hospice provider without worrying that your Medicare won’t pay. If you go off of hospice, you can return to your Medicare Advantage plan.
There is also the option for home hospice or in other locations like an assisted living, nursing home, or special hospice residential community. Keep in mind that you will have additional costs related to room and board in a residential hospice community or nursing home.
Medicare does not pay for room and board under the hospice benefit. Hospice can also be provided short-term in a hospital setting, but the hospice team must make the arrangements. Otherwise, you could be responsible for the cost of that hospital stay.
What Are the Medicare Hospice Benefits for this Year?
Hospice benefits will change in 2021. The most significant change will be to allow Medicare Advantage plans to offer the hospice benefit. Some have expressed concerns about this change, which includes the incentive to provide care at the lowest cost under a “Medicare Advantage carve-in,” or ad-hoc addition of services provided by hospice.
For the remainder of 2020, original Medicare (Part A) covers hospice benefits regardless of whether you have a Medicare Advantage plan or not. You have to continue paying the premiums for your Medicare Advantage plan if you want to keep it to cover anything unrelated to your hospice diagnosis. For example, if you break a hip, your Medicare Advantage plan or original Medicare will cover those costs since they are irrelevant to your terminal diagnosis.
To receive hospice benefits, you will be asked to sign a statement stating that you agree to accept the Medicare-covered hospice services and not seek other Medicare-covered treatment for your terminal illness.
What hospice pays for
Hospice pays for a lot, but it does not pay for 24-hour nursing or aide care. It does pay for 24-hour emergency access to nursing and physician services. It can help to think of hospice as a team of providers dedicated to comfort care and pain relief. Hospice staff is trained in end-of-life care and pain management. These healthcare and social service providers consist of:
- A supervising physician. Most hospice companies have their own physician unless you insist on keeping the one you have. Your primary care physician might be hospice-board certified, but it is unlikely. Most people opt to turn their care over to the hospice company physician.
- Nurses and licensed practical nurses (LPNs)
- Physical, speech, occupational, and respiratory therapists
- Social workers
- Bereavement counselors
- Hospice Chaplains, or in-house spiritual care
- Dietary services
- Music therapy
- Short-term inpatient care for pain management
- Short-term respite care (you may have to pay 5 percent of the daily rate for respite care)
- Family meetings to discuss coordination of care. These family meetings help inform families about the dying process and what to expect. Meetings are also a time for your loved one to discuss their concerns and questions about hospice care.
Someone on hospice also has prescription drug and medical equipment needs. When it comes to these physical tools and needs, the hospice benefit can also pay for the following:
- A hospital bed
- Pressure-reducing mattresses
- A wheelchair or other mobility device
- Bandages, catheters, and other medical supplies
- Drugs to treat pain and provide symptom relief
Any of the services mentioned above need to go through a hospice-contracted company. Under the hospice benefit, you will also not be responsible for any insurance deductibles that might otherwise apply.
What hospice does not pay for
The most critical thing to consider before deciding to call or start hospice is whether you are willing to discontinue curative treatments. It is not uncommon for people to recover while on hospice despite not receiving curative treatment. There is speculation that the comfort care patients receive has a positive effect on their overall health and well-being.
For you to continue to receive the Medicare hospice benefit, you must adhere to strict criteria. The hospice requirements for continued participation ask first and foremost that you do not seek treatment to cure your terminal illness. However, you always have the right to revoke the hospice benefit if you wish to resume treatment.
In addition, hospice will not pay for any care your hospice company did not arrange. For example, you can’t make appointments to see another healthcare provider that isn’t approved by hospice, unless you have chosen them to be your attending healthcare provider for hospice. For example, you can’t go to another health provider for the purposes of consultation on your terminal illness.
You can’t go to the hospital unless arranged by your hospice provider. Hospital stays are generally short-term to help manage symptoms. Also, you can’t seek any emergency care to treat your terminal illness. If you call 911 and ask to be transported to the emergency room, you will be responsible for the transportation and treatment you receive in the ER.
Some people think that hospice is synonymous with no treatment at all, which is not the case. Common interventions like taking an antibiotic to treat a urinary infection, or using oxygen to relieve stressed breathing are considered appropriate for symptom relief.
The other misconception is that people are denied fluids or food on hospice. If a patient wants to eat and drink, they are assisted with doing so as long as it is safe. Interventions such as feeding or breathing tubes would be discouraged, but not always prohibited.
Some families face the dilemma and frustration of their loved ones needing more care than hospice can provide. This is especially true of patients at home, but can also apply to people in assisted living. The hospice benefit does not include an aide every day for several hours a day to help someone to the bathroom, transfer out of bed, or assist with eating and drinking. In these situations, the family has to pitch in or hire private caregivers to help with care.
How Long Will Medicare Pay for Hospice?
Medicare starts with two 90-day periods for hospice. After that, you can continue on hospice indefinitely as long as you continue to be recertified for 60-day periods, meaning that the physician must certify again that you have six months to live each time. Patients are sometimes on hospice for several certification periods.
If you decide to revoke hospice, you can at any time. Later, if you meet the criteria, you can also go to hospice again. You can also choose to change hospice companies during a certification period, and will still be covered.
The specific reasons Medicare will stop paying for hospice are the following:
- If a doctor refuses to certify you have a terminal illness.
- You opt for treatment of your condition.
- You revoke hospice.
- You recover sufficiently to the extent that hospice is no longer needed.
Medicare Can Help With Hospice
Our healthcare system focuses on treatment, and this creates a mindset that expects curative measures. The process of coming to terms with the end of life is not an easy one. The goal of comfort care is to relieve suffering, and improve quality of life while respecting the dying person’s wishes.
Talking with your family and your loved one about hospice care can open a valuable dialogue that can help you make an informed and compassionate decision.
- “How Hospice Works.” Medicare.gov, www.medicare.gov/what-medicare-covers/what-part-a-covers/how-hospice-works
- “FAQ: What Type of Terminal Illnesses Does Hospice Treat?” American Hospice Foundation, americanhospice.org/learning-about-hospice/what-type-of-terminal-illnesses-does-hospice-treat/
- Holly, Robert. “In Under Medicare Advantage.” Home Healthcare News. 18 January 2019, homehealthcarenews.com/2019/01/cms-to-test-hospice-carve-in-under-medicare-advantage/
- “Medicare Hospice Benefits.” Medicare.gov, www.medicare.gov/Pubs/pdf/02154-Medicare-Hospice-Benefits.PDF
- “Hospice Care: What Does Medicare Cover?” Healthline, www.healthline.com/health/medicare/does-medicare-cover-hospice