What You Didn’t Know About Medicare and Hospice
I recently had a personal experience with Medicare as my 92-year-old mother entered the final stage of hospice care. I feel it’s important to explain hospice so that those with a terminally ill loved one can understand its value. This information was provided by the hospice team caring for my mother.
Hospice is often misunderstood by caregivers, and many delay discussing it with their loved one’s doctor.
Many Americans believe hospice is only for the final days to help someone die peacefully. I was fortunate that the home health company assisting my mother explained her hospice eligibility and advised me to consult her primary care physician. This process began over two years ago, making the transition less stressful.
Here is some helpful information about hospice:
- Healthcare Professionals: Hospice teams include physicians, nurses, social workers, spiritual counselors, certified nursing assistants, and volunteers. Care is provided wherever the patient resides.
- Medicare Coverage: The 2024 Medicare & You handbook (page 26) explains that Medicare covers hospice under Part A. A doctor must certify that the patient is terminally ill with six months or less to live. Patients opting for hospice agree to receive comfort care (palliative care) instead of curative treatment and must sign a statement choosing hospice over other Medicare-covered treatments for the terminal illness.
- Recertification: Hospice care can be recertified every six months by a hospice medical director or doctor if the patient remains terminally ill, as in my mother’s case. Original Medicare will be billed for hospice care.
- Coverage Details: Hospice covers all medical care related to the terminal illness, while Original Medicare or a Medicare Advantage Plan covers unrelated health issues (co-pays apply). Medicare-certified hospice care is typically provided at home or in a facility like a nursing or personal care home. Additional details are available in Chapter 2 of Toni’s Medicare Survival Guide Advanced Edition.
Medicare Costs Under Hospice:
- You pay nothing for hospice care (Medicare covers it).
- You pay a copayment of up to $5 per prescription for outpatient drugs for pain and symptom management.
- You pay nothing for Medicare-approved inpatient respite care, which provides a 5-day stay in a facility to give at-home caregivers a break.
Hospice offers comfort, dignity, love, and support. Consult your loved one’s doctor if you have concerns or need advice on navigating this Medicare journey for terminal healthcare issues.
Remember, with Medicare, it’s what you don’t know that WILL hurt you! If you have a Medicare question, email [email protected] or call 832-519-8664. Toni’s new Confused about Medicare” video series and Toni’s Medicare books are available HERE.
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Originally published September 10, 2024
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