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Medicare Beneficiaries Needing Hospice Care May be Covered

Posted by Medicare Made Clear

hospice careHospice care has the goal of providing comfort and relief from pain and other symptoms to terminally ill patients during the final days of their life. Hospice may also provide emotional and spiritual care to patients and their families. This type of care is called palliative care.

Hospice can take place in the home or in an inpatient hospice facility, depending on individual circumstances.

Paying for Hospice Care

Medicare Part A, Medicaid and most private insurance plans cover hospice care. Even if you have a Medicare Advantage plan, Medicare Part A covers the costs associated with hospice care. However, you may have to pay  a $5 copayment per prescription for out[aient prescription drugs for pain and symptons management. Additionally, there is a 5% coinsurance of the Medicare-approved amount for inpatient respite care.

The hospice benefit under Medicare Part A does not cover curative care. This means the hospice benefit will not pay for any treatment to try and cure the primary or related condition or illness. Keep in mind that a hospice patient can resume curative treatment at any time, hospice will not pay for it. 

The Medicare Part A benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods. According to MedicareRights.org, the patient must meet with a hospice doctor or nurse practitioner if he or she reaches a third benefit period. The third benefit period begins on day 180 of hospice.1 Read more about hospice benefit periods.

Qualifications for Medicare-Covered Hospice Care

Original Medicare will cover hospice care if the patient has Medicare Part A and meets all of the following conditions.

  • The hospice medical director and the patient’s doctor certifies the patient has a terminal illness.1
  • The patient signs a statement electing to have Medicare pay for palliative care such as pain management, rather than care to try to cure the condition.1
  • The terminal condition is documented in the medical record.1
  • The patient receives care from a Medicare-certified hospice agency.1

Conclusion

If you have Original Medicare and need hospice care, Medicare Part A will cover all costs if you meet the eligibility requirements listed above. If you have a Medicare Advantage plan, Medicare Part A still covers the costs associated with hospice care. Contact your plan’s customer service department to speak to a representative if you have questions.

Related Content

November is National Hospice Palliative Care Month

Finding a Medicare-Certified Hospice Care Program

Can Medicare Help with Home Health and Hospice Care?

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

1 Dear Marci, Vol. 14, Issue 22, Medicare Rights Center, November 2, 2015

Resources:

November is National Hospice Palliative Care Month , Medicare Made Clear, May 03, 2012

Dear Marci, Vol. 14, Issue 22, Medicare Rights Center, November 2, 2015

 

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