Understanding Medicare’s Hospice Benefit

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Understanding Medicare’s Hospice Benefit

If you are in the State of New Jersey and would like to discuss Medicare or your estate plan, our team at Willis Law Group LLC is here to provide you with any assistance that you may need. To schedule a consultation, we encourage you to give our main office a call at (877) 296-2575 or attend one of our free educational workshops throughout New Jersey.

Medicare’s hospice benefit covers any care that is reasonable and necessary for easing the course of a terminal illness. It is one of Medicare’s most comprehensive benefits, and it can be extremely helpful to both the terminally ill individual and his or her family. However, it is not understood by most people and is very underutilized. Understanding what is offered ahead of time may help Medicare beneficiaries and their families make the difficult decision to choose hospice if the situation arises.

The focus of hospice is palliative care, which means helping people who are terminally ill so their families maintain their quality of life. Palliative care addresses physical, intellectual, emotional, social, and spiritual needs while also supporting the terminally ill individual’s independence, access to information, and ability to make choices about his or her health care.

The first qualification for Medicare’s hospice benefit is that a beneficiary must be entitled to Medicare Part A. Additionally, a doctor must certify that the beneficiary has a life expectancy of six months or less. If the beneficiary lives longer than six months, the doctor can continue to certify the patient for hospice care indefinitely. The beneficiary must also agree to give up any treatment to cure his or her illness, electing to only receive palliative care. This can seem overwhelming, but beneficiaries can also change their minds at any time. It is possible to revoke the benefit and reelect it later, and to do this as often as necessary.

Medicare will cover any service that is reasonable and necessary for easing the course of a terminal illness. Hospice nurses and doctors are on-call 24 hours a day, 7 days a week, in order to give beneficiaries support and care when needed. Services are usually provided in the home and are considered appropriate if aimed at improving the beneficiary’s life and making him or her more comfortable.

The Medicare hospice benefit provides for:

  • Physician and nurse practitioner services
  • Nursing care
  • Medical appliances and supplies
  • Drugs for symptom management and pain relief
  • Short-term inpatient and respite care
  • Homemaker and home health aide services
  • Counseling
  • Social work service
  • Spiritual care
  • Volunteer participation
  • 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 was not 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 housing 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, either inpatient or outpatient, or ambulance transportation unless it arranged by the hospice team. The beneficiary can use regular Medicare to pay for any treatment not related to the beneficiary’s terminal illness.

For more information to help you understand Medicare’s hospice benefit:

  • Download Medicare’s booklet on the hospice benefit, click here.
  • For more information about Medicare’s hospice benefit, click here.
By |2019-08-06T19:36:41-05:00August 6th, 2019|Family Planning, Medicaid Planning|

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