Visualization of How Long does Medicare Pay for Hospice

How long does Medicare pay for hospice? This is a question that has been frequently searched on the internet, but I am here to help you understand it.

Hospice care is for people expected to live for six months or fewer because of illness.

If you end up living longer than six months, you can still receive hospice care as long as the hospice doctor confirms that you are still terminally ill.

The care is provided in specific periods, starting with two 90-day periods and followed by an unlimited number of 60-day periods.

Each period begins when you receive hospice care and ends when the respective 90 or 60 days are over.

In the first 90-day period, both your hospice doctor and your regular doctor (if you have one) must certify that you have a life expectancy of six months or fewer.

It is important to note that for each subsequent period after the initial 90 days, the hospice doctor must confirm again that you are still terminally ill for you to continue receiving hospice care.

Once your hospice benefit begins, you don’t have to keep choosing hospice care for each new period.

You can read more about the extensive details of hospice in this comprehensive guide.

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Which two conditions must be present for a patient to enroll in hospice?

If you have Medicare Part A (Hospital Insurance) and meet the following conditions, you are eligible for hospice care:

  1. Your hospice doctor and, if applicable, your regular doctor certify that you are terminally ill, with an expected life expectancy of 6 months or fewer.
  2. You opt for comfort care (palliative care) instead of seeking treatment to cure your illness.
  3. You provide a statement indicating your choice of hospice care over other Medicare-covered treatments for your terminal illness and related conditions.

It’s important to note that you have the right to change your mind and receive treatments for your terminal illness if you decide to do so.

You can read more about the extensive details of Medicaid and hospice in this comprehensive guide.

What is not covered under the Medicare hospice benefit?

Your hospice benefit will not cover certain things once it starts:

  1. Treatment aimed at curing your terminal illness or related conditions. If you’re considering such treatment, talk to your doctor. You have the right to stop hospice care at any time.
  2. Prescription drugs are not for your terminal illness or related conditions. These drugs aren’t part of the hospice benefit but may be covered by your Medicare drug plan (Part D), with a possible copay.
  3. Care from providers not arranged by the hospice medical team. You must receive hospice care from your chosen hospice provider, but you can still see your regular doctor if selected as the attending medical professional.
  4. Room and board expenses. Hospice benefits don’t cover these, except for short-term inpatient or respite care services arranged by the hospice team, which Medicare may cover with a small copayment.
  5. Care received as a hospital outpatient, inpatient, or ambulance transportation is unrelated to your terminal illness unless arranged by your hospice team.

You can read more about the extensive details of Medicaid in this comprehensive guide.

What are the advantages of hospice?

You might have wondered about hospice benefits, but I am here to explain them and clear up any confusion.

Let us talk about the advantages of hospice care:

  1. Avoiding Unwanted Hospitalizations: The goal of hospice care is to provide hospital-like care but in a safe and comfortable home environment. If a problem arises, a nurse can come to your home, assess the situation, and share the information with the doctor. This may prevent the need for going to the hospital.
  2. Cost-effective: Choosing hospice care won’t cost you anything out of your pocket because it’s covered by insurance. Most Medicare, medical, or private insurance plans cover 100% of hospice care expenses.
  3. Available 24/7: Nurses are available 24 hours a day if you need assistance. You can contact the hospice staff in case of an emergency, and they’ll be there to help you, day or night.
  4. Interdisciplinary Team: The hospice team includes doctors, nurses, therapists, counselors, home health aides, and volunteers. They make periodic visits to the patient throughout their time in hospice care.
  5. Supplies Delivered to Your Door: Whatever you need when facing a terminal illness, we make sure it’s supplied and delivered directly to your door. This includes medicines, medical equipment (like hospital beds, oxygen, wheelchairs, and walkers), and medical supplies (such as skin creams, latex gloves, and bedpans).
  6. Pain and Symptom Management: Hospice care aims to improve the quality of life by reducing pain and symptoms associated with illness through the use of medicine and therapy.
  7. Emotional and Spiritual Support: Counselors and chaplains are available for emotional and spiritual support upon request. There’s also a bereavement support program for both the patient and their family, both before and after the patient passes away.

What are the disadvantages of hospice?

Like anything that has advantages, hospice care also has disadvantages.

While providing comfort and support, it carries limitations that one must consider.

  1. Must Forgo Curative Treatment: One significant disadvantage is that patients must give up on curative treatment. This is because aggressive treatment may cause symptoms that could negatively impact the patient’s quality of life, which goes against the core principle of hospice care: providing comfort.
  2. Caregiver Not Provided: Unlike some other forms of care, hospice care does not include a provided caregiver. This means that family members may need to take on the caregiving responsibilities themselves. If family members are unable or unavailable, hiring a private caregiver becomes necessary. Where neither option is feasible, the alternative might be seeking care in a nursing home.

It’s important to acknowledge that, while hospice care offers invaluable support, these limitations can impact the decision-making process for both patients and their families.

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