Does Medicare Pay For Hospice?
What Is Medicare Hospice?
Medicare pays for hospice, but what is hospice exactly?
Medicare defines hospice as a program of care and support for people who are terminally ill. Terminal illness, as Medicare definites it, is a life expectancy of six months or less. The primary goal of hospice in Medicare is to help terminally ill people live a comfortable life and manage their pain and discomfort. Hospice care is palliative care versus skilled nursing and home health care. Hospice does not cure the patient but rather aids the person in the dying process.
Death & dying is an area most people do not wish to ponder, so there are many misconceptions about Medicare-covered hospice care.
What Medicare Hospice Is Not?
Hospice is not a place. When my mother was terminally ill with ovarian cancer, I was thinking of taking her to a place.
When I was in college in the 80s, I had volunteered in a hospice facility run by the Hawthorne Dominican sisters. The hospice facility was an actual place people went to die. The nuns took care of everything: medical, personal care, food & lodging; and patients stayed there until the end.
That is what I had in mind when the doctors spoke to my family about hospice for our mother. That is not, however, how Medicare thinks of hospice.
Medicare does not pay for a hospice facility that provides room & board unless the care is tied to something like a skilled nursing facility. Medicare does, however, pay for hospice personnel and the medications they administer during hospice.
Where Do You Go For Hospice?
Hospice can be given virtually anywhere. A Medicare beneficiary can receive hospice at a hospital, hospice in a skilled nursing facility, hospice in an assisted living residence, and hospice at home. Medicare will pay for hospice care in assisted living, nursing homes, and other facilities if it is a Medicare-approved facility.
The end of life movement that started in the ’70s sees passing at home as the ideal. Most Medicare patients, when surveyed, prefer hospice in the home. That is where people feel most comfortable, but because of the level of care required, hospice care may have to move to a hospital in the last few days or another location.
What Kind of Illness Makes You Hospice Eligible?
When we think of hospice, we usually think of cancer, but there are other illnesses that result in hospice.
Grandpa Joe was 98. Grandpa had beaten cancer 4 times, lockjaw, and the Second World War. Dying didn’t seem possible. He had always been there, and we grandkids assumed he would always be there. Terminal illness and Grandpa Joe didn’t fit.
When Grandma Hilda announced to the family, Grandpa had congestive heart failure and was going into hospice, it didn’t quite register with us grandkids.
Grandpa Joe seemed the same old Grandpa Joe. When I was home from college, we chatted about the Cornhuskers, baseball, and politics. Nothing seemed to have changed, but there was a procession of nurses and therapists who came in and out of their home.
When Grandma Hilda finally called to tell us Grandpa had passed in his sleep, his death hit me like a sledgehammer.
Grandpa’s passing was hard on everyone, but Medicare providing and paying for hospice lightened the burden, especially for my parents and grandparents.
Who Can Go Into Hospice?
Hospice is also not exclusively for the old. I have a number of clients who are in their twenties and thirties. Not everyone on Medicare is sixty-five and older, though the majority are.
Accidents or illnesses permanently disabled some, and some are terminal. Hospice is for them too.
How Much Is Hospice?
Hospice care is not expensive for those on Medicare. Medicare pays for the vast majority of the hospice costs under Medicare Part A with very little out-of-pocket costs. Medications, some equipment, and nurses are covered.
Like I said earlier, hospice does not usually include custodial care or housekeeping. That can be very costly if the family cannot provide that type of care themselves.
How Do You Get Medicare To Pay For Hospice?
A Medicare beneficiary is eligible for Medicare’s hospice care benefit if she is entitled to Medicare Part A and meets the following conditions.
- The hospice doctor and the person’s regular physician certify that the person is terminally ill with a life expectancy of six months or less if the illness runs its expected course.
- The person accepts palliative care for comfort instead of care to cure her illness.
- The person must sign a statement choosing hospice care instead of other Medicare-covered treatments for her terminal illness and related conditions.
- The care is provided by a Medicare-certified hospice agency.
When these 4 critical are met, Medicare pays for hospice. At any time, a person may choose to exit hospice.
Is Hospice Euthanasia?
Hospice does not accelerate the dying process.
I have had people describe hospice to me as akin to euthanasia where someone actively terminates a life. Hospice is not euthanasia or assisted suicide. You do not intentionally cut short a person’s life. Hospice is about allowing the dying process to take its natural and inevitable course without assistance. Hospice care is about alleviating the suffering and providing comfort while the person dies.
An uncle of mine was a retired Omaha police captain. Uncle Bill had a severe stroke with many complications. He was put on a ventilator.
Uncle Bill was a strong and courageous individual. A vegetative existence was not for him not to mention impoverishing his wife with medical bills. He ordered the ventilator turned off.
Without the ventilator, he would quickly stop breathing. He knew it. The doctors made him as comfortable as possible with heavy sedation. His body fought hard against the loss of breath.
We gathered around his hospital bed. Over the course of a day, he passed peacefully from this life to next surrounded by his loving wife and children.
Hospice Is Up To You
I’ve known many individuals over the years who have gone on hospice for a time. Instead of dying, their health improved, or they resumed a normal life and quit hospice because the decline stopped. You are free to remove yourself from hospice at any time.
Hospice Is Also For The Living
Hospice is the option when all other alternatives have been exhausted. It is the option to bring the highest possible quality of life to a person’s remaining time. The hope is family members will look back on their time and know that everything was done to preserve, prolong, and then peacefully say goodbye.
While you may struggle with the challenge of terminal illness, the end of your life and hospice is as much about your loved ones as it is about you. Watching you suffer and your family’s grief afterward will be their burden. Dying is equally about them. Understanding that there is something for them as well as you in a scary time can give you all hope that the last great challenge in life will be a little less daunting.
While hospice ends with a patient’s death, family grief counseling can continue for up to a year. Medicare pays for that hospice care too.
One’s mortality is difficult to face, but the chance you will go on Medicare hospice at the end of your life is more than 50%. That is an extraordinary number, so having confidence Medicare will pay for hospice is critical.