My mother-in-law has a terminal condition and is nearing the end of her life. I’m helping her figure out the logistics of hospice care but do not know how her Medicare will cover it. How does Medicare cover hospice?
-Dottie (St. Johns, MI)
I’m so sorry to hear about your mother-in-law’s health. I hope the following information with be helpful to you and your family during what I imagine is a very challenging time.
Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit is primarily home-based and covers end-of-life palliative treatment, including support for one’s physical, emotional, and other needs. It is important to remember that the goal of hospice is to help an individual be as comfortable as possible, not to cure an illness.
To elect hospice, someone must:
- Be enrolled in Medicare Part A
- Have a hospice doctor certify that they have a terminal illness, meaning a life expectancy of six months or less if the illness takes its normal course
- Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care
- And, receive care from a Medicare-certified hospice agency
Once an individual chooses hospice, all of their hospice-related services are covered under Original Medicare, even if they are enrolled in a Medicare Advantage Plan, unless their Medicare Advantage plan is part of a specific demonstration program, in which case the plan will pay for hospice care. Their Medicare Advantage Plan will continue to pay for any care that is unrelated to their terminal condition. Original Medicare payments to the hospice provider also cover any prescription drugs needed for pain and symptom management related to the terminal condition. The individual’s stand-alone Part D plan or Medicare Advantage drug coverage may cover medications that are unrelated to their terminal condition.
The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods The doctor must recertify the person’s terminal illness before each benefit period.
If someone you care for is interested in Medicare’s hospice benefit:
- Ask their doctor whether they meet the eligibility criteria for Medicare-covered hospice care.
- Ask their doctor to contact a Medicare-certified hospice on their behalf.
- Be persistent. There may be several Medicare-certified hospice agencies in your area. If the first one you or the doctor contact is unable to help, contact another.
Once you have found a Medicare-certified hospice:
- The hospice medical director (and the individual’s regular doctor if they have one) will certify that they are eligible for hospice care. Afterwards, the individual must sign a statement electing hospice care and waiving curative treatments for their terminal illness.
- Their hospice team must consult with the individual (and their primary care provider, if they wish) to develop a plan of care. Their team may include a hospice doctor, a registered nurse, a social worker, and a counselor.
I hope this helps you and your mother-in-law know where to start with getting Medicare-covered hospice care.