Understanding the Medicare Hospice Benefit


Electing Hospice care is a major life decision, and an important thing to know is that you can always change your mind.

The Medicare Hospice Benefit functions differently from the other benefits in that it is always billed under Original Medicare even if you are enrolled in a Medicare Advantage plan.  When you elect Hospice Care all treatments related to the terminal illness fall under Original Medicare.  If you are enrolled in Medicare Advantage, all services not related to the terminal illness remain under Medicare Advantage.

While you agree to move to palliative care for your terminal illness, you do not lose your other Medicare Benefits.  For example, if you are enrolled in a plan with dental benefits, you will still be able to utilize them.  You do not lose access to care by electing the hospice benefit.

Drugs for symptom management related to your terminal illness are covered under the Hospice Benefit.  Drugs for unrelated conditions will fall under your Part D plan or Medicare Advantage.

The initial hospice benefit period is two 90-day periods (6 months).  After that, the benefit requires a face-to-face meeting with a hospice doctor or nurse practitioner every 60 days before each additional period.   If your prognosis improves you may leave hospice care but return any time you are eligible.

You can also end hospice with or without a doctor’s consent.  If you elect to do so, you can resume curative treatments.  You will also need to update your Part D plan status to avoid medication denials.  If you end hospice, you can elect it again later if you choose to and you continue to meet the eligibility requirements.

Respite Care is an important and often overlooked benefit.   Respite care is temporary care for the patient in a facility setting.  This allows the primary caregiver time to rest from the rigors of caregiving.   It is not a permanent move-in the UK they sometimes call it taking a break.

Medicare covers Respite Care in a Medicare approved facility.   Each visit can last up to 5 days.   Medicare does not pay for in home Respite Care.  This benefit is so that your regular home care giver can rest and recharge.    Respite can delay or eliminate the need for facility placement later.

To learn more about what hospice is and how it functions https://hospicefoundation.org/Hospice-Care/Hospice-Services.

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