Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness A terminal illness is a disease or condition that cannot be cured or adequately treated, with a life expectancy of six months or fewer. . Medicare’s hospice benefit offers end-of-life palliative treatment, including support for your physical, emotional, and other needs. It is important to remember that the goal of hospice is to help you live comfortably, not to cure an illness.
To elect hospice, you must:
- Be enrolled in Medicare Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care.
- Have a hospice doctor certify that you have a terminal illness, meaning a life expectancy of six months or less
- Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care Curative care is the treatment of a patient with the intent of curing the patient’s disease or condition. For example, chemotherapy treatments to cure breast cancer.
- And, receive care from a Medicare-certified Medicare-certified means offering services at a level of quality approved by Medicare. Medicare will not pay for services received from a health care provider that is not Medicare-certified. hospice agency
Once you choose hospice, all of your hospice-related services are covered under Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. , even if you are enrolled in a Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan. Your Medicare Advantage Plan will continue to pay for any care that is unrelated to your terminal condition. Hospice also should cover any prescription drugs you need for pain and symptom management related to your terminal condition. Your stand-alone Part D plan or Medicare Advantage drug coverage may cover medications that are unrelated to your terminal condition.
The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods, pending recertification by a doctor.
If you are interested in Medicare’s hospice benefit:
- Ask your doctor whether you meet the eligibility criteria for Medicare-covered hospice care.
- Ask your doctor to contact a Medicare-certified hospice on your behalf.
- Be persistent. There may be several Medicare-certified hospice agencies in your area. If the first one you contact is unable to help you, contact another.
Once you have found a Medicare-certified hospice:
- The hospice medical director (and your doctor if you have one) will certify that you are eligible for hospice care. Afterwards, you must sign a statement electing hospice care and waiving curative treatments for your terminal illness.
- Your hospice team must consult with you (and your primary care provider, if you wish) to develop a plan of care A plan of care is a doctor’s written plan describing the type and frequency of health services a particular patient needs. . Your team may include a hospice doctor, a registered nurse, a social worker, and a counselor.