Medicare’s Hospice Benefit

Krupp & Krupp, LLP Blog

Monday, January 7, 2019

Medicare’s Hospice Benefit

Medicare’s hospice benefit covers any necessary and reasonable care for easing the course of a terminal illness. This benefit is often overlooked and underused.

Hospice is a type of palliative care. Palliative care addresses physical, intellectual, emotional, social, and spiritual needs of the terminally ill.

A patient with Medicare Part A will qualify for Medicare’s hospice benefit if a doctor certifies that the patient has a life expectancy of six months or less. What if the patient lives longer than six months?  The doctor can continue to certify the patient for hospice care indefinitely. The patient must also agree to give up any treatment to cure the terminal illness and elect to receive only palliative care. The patient may revoke the hospice benefit and re-elect it later.  This allows a patient to change his or her mind and receive treatment for the terminal illness.

The hospice benefit will cover care that is reasonable and necessary for easing the course of a terminal illness. Services are usually provided in the home. Services are considered reasonable and necessary if they are aimed at improving the patient’s life and making him or her more comfortable.

Examples of the services that the hospice benefit will provide for:

  • Physician and nurse practitioner services
  • Nursing care
  • Medical equipment
  • Homemaker and home health aide services 
  • Drugs for symptom management and pain relief 
  • Short-term inpatient and respite care 
  • Social work service 
  • Spiritual care 
  • Bereavement services 

Because the beneficiary is electing palliative care over treatment, there are things the hospice benefit will not cover:

  • Treatment to cure the beneficiary’s illness. 
  • Prescription drugs other than for symptom control or pain relief. 
  • Care from a provider that wasn’t set up by the hospice team, although the beneficiary can choose to have his or her regular doctor be the attending medical professional. 
  • Room and board. If the beneficiary is in a nursing home, hospice will not pay for room and board costs. However, if the hospice team determines that the beneficiary needs short-term inpatient care or respite care services, Medicare will cover a stay in a facility. 
  • Care from a hospital for the terminal illness, either inpatient or outpatient, or ambulance transportation unless it arranged by the hospice team. However, the beneficiary can use regular Medicare to pay for any treatment not related to the beneficiary’s terminal illness. 

You can download Medicare’s booklet on the hospice benefit:

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