Hospice Coverage- What You Need To Know

Oct 12, 2014

Making our loved ones comfortable for the last days of their life is priceless, but how can you make sure you aren’t sinking your own ship? Determining how your family will handle payment for hospice care may seem daunting.

What many don’t know is that there’s hospice coverage that provides basic hospice services at little to no cost. Medicare has an all-inclusive Hospice Benefit that can assist dying patients and their family members with hospice payment and coverage at the end of life.

What Medicare Covers

Your family’s doctor and any hospice care team will determine a hospice plan that suits your needs based on your loved one’s diagnosis. Any person is eligible to receive Medicare hospice benefits if, after a physician and a medical director determines that that person does have 6 months of less to live, that person is eligible for Medicare Part A hospital insurance, agrees to use hospice care instead of any other Medicare-covered treatments for illness, and if that person also agrees to receive hospice care from a Medicare-approved program.

When related to a terminal illness, Medicare Hospice Benefits will cover the following services that will manage pain and symptoms related to a terminal illness:

  • An initial hospice consultation with a physician
  • Doctors and nurses services
  • Medical equipment and supplies
  • Hospice aid (bedside care and helping patients with routine activities of daily living)
  • Physical, occupational, and speech therapy
  • Emergency room visits, ambulance transportation, and short-term hospital care
  • Social services
  • Nutritional counseling
  • Grief counseling

And Medicare will offer short-term respite care coverage and drugs for symptom and pain relief each for small co-payments.

What Medicare Doesn’t Cover

It is important to remember that choosing hospice care means either your family or your doctor have determined that curing the terminal illness of your loved one is no longer an option. Medicare Hospice Benefits reflect that notion with what they don’t cover during hospice care. Any treatments that are meant for curative purposes are not covered by Medicare including medications.

Any hospice care your loved one receives must be approved by the chosen hospice care team. Without the proper approvals, your loved one’s care may not be covered.

Lastly, and most importantly, Medicare does not cover room and board.  A patient needing short-term inpatient care services like physical therapy can get room and board in a treatment facility covered with a small co-pay, however patients who permanently reside in nursing homes will not get room and board covered by Medicare. While you can choose another form of payment for this, including Medicaid, all parties (hospice care, nursing home, and payer of room and board) must agree on the care. This is an important factor to consider when choosing a nursing home for your loved one.

Making sure your loved ones are taken care of at the end of their lives doesn’t mean you have to suffer financially. Know your options so you can determine what is best for your family.

Contact the Law Offices of Christina Lesher today at (713) 529-5900 for any guidance or assistance in life-care planning.

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