Medicare Corner
1.What is hospice care? 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 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 be as comfortable as possible, not to cure an illness. 2.What is Medicare’s hospice benefit? To elect hospice, you must: • Be enrolled in Medicare Part A • Be certified, by the hospice doctor and your regular doctor (if you have one), to 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 you choose hospice, all of your hospice-related services are almost always covered under Original Medicare, even if you are enrolled in a Medicare Advantage 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
• Skilled nursing services • Skilled therapy services • Hospice aides and homemaker services • Durable medical equipment (DME) • Respite care
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 health care provider whether you meet the eligibility criteria for Medicare-covered hospice care. • Ask your health care provider 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 regular 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. Your team may include a hospice doctor, a registered nurse, a social worker, and a counselor. 3.What services are covered under the hospice benefit? If you qualify for the hospice benefit, Medicare covers the following:
• Short-term inpatient care • Medical social services • Prescription drugs
• Spiritual or religious counseling • Nutrition and dietary counseling How does hospice coverage work for an individual with a Medicare Advantage Plan? Hospice care is almost always covered under Original Medicare, even if you have a Medicare Advantage Plan. If you have a Medicare Advantage Plan and need care unrelated to your terminal condition, you can choose to either see providers in your plan’s network or see Original Medicare providers. Your Medicare Advantage Plan or Part D plan should also cover prescription drugs unrelated to your terminal condition, and the plan’s cost and coverage rules will apply. Your Medicare Advantage Plan will also continue to cover any additional benefits it provides, such as vision or dental services. For more information, contact PCOA Medicare at (520) 546-2011.
June 2023, Never Too Late | Page 9
Pima Council on Aging
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