Who Pays for Hospice if My Loved One Receives Medicare?

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Dear Toni,

As a certified case manager and critical care unit RN, I advise spouses and adult children who are seeking advice for their parents or spouses that are having end-of-life issues. Those who have serious healthcare issues should be offered every option for proper planning for end-of-life care, especially hospice!

Can you explain hospice and respite care to your readers? I am sure it will help those who are seeking assistance for their frail loved ones while allowing the primary caregiver some well-needed rest.

Thanks,

Susan from Spring, Texas

Susan,

HOSPICE…a subject no one wants to discuss with an elderly loved one. When a loved one is terminally ill, it takes an emotional toll on the caregiver and the family, as well as the patient. 

Many Americans wait too long to discuss hospice benefits with the patient’s doctor because they believe hospice is for the last days to help a person die peacefully. They are not aware that hospice can give hope along this journey through education, medication to manage symptoms, support to the patient and family, and counseling services for the patient, family members, and caregivers. 

Healthcare professionals in the hospice system include physicians, nurses, social workers, spiritual counselors, certified nursing assistants, and volunteers. A hospice provider comes to where the patient lives to provide the care.

The Medicare & You handbook explains what hospice is in Medicare terms and what Medicare covers for hospice under Part A of Medicare. A doctor who orders hospice must certify that a patient is terminally ill and has 6 months or less to live. When a patient agrees to hospice care, they agree to comfort care (palliative care) instead of treatment to cure the illness and must sign a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness.

Hospice can be recertified every 6 months by a hospice medical director or hospice doctor if the patient is still terminally ill. Original Medicare will be billed for hospice care.

Hospice will cover all medical care for terminal illness and Original Medicare or Medicare Advantage Plan will pay for health problems that are unrelated (co-pays will apply). Medicare-certified hospice care is usually given in the home or other facility, like a nursing or personal care home. Additional details on hospice are explained in Chapter 2 of the Medicare Survival Guide Advanced Edition.

Hospice Costs with Medicare

You pay nothing for hospice care. Medicare pays.

You pay a copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.

You pay nothing for Medicare-approved inpatient respite care, which is a    5-day stay in a Medicare-approved facility so that the caregiver can have a period of rest.

You can go on this journey helplessly or choose to have control over your or a loved one’s end-of-life plan of care. Know that hospice provides comfort, dignity, love, and support. Talk with a geriatric case manager or geriatric doctor if you have concerns or need advice on your loved one’s terminal healthcare issue.

Currently, my mother is in hospice, due to dementia, and I am experiencing everything that hospice offers. It is truly a blessing for those who have a terminally ill loved one!

For assistance with enrollment and personalizing your Medicare, contact the Toni Says® office at 832/519-8664 or email your Medicare questions to info@tonisays.com.

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