Medicare's Hospice Benefit: Little Known, Little Used

Dealing with a terminal illness can be challenging, especially when faced with managing pain, affording medications, and obtaining support for caregiving. It may come as a surprise to some Medicare beneficiaries that Medicare offers an all-inclusive Hospice Benefit to help dying patients and their loved ones navigate these concerns during the end-of-life stage.

According to Mary T. Berthelot, a staff attorney at the Center for Medicare Advocacy, the hospice benefit is not being used to its full potential. In fact, statistics from 2000 show that a mere 23 percent of Medicare beneficiaries who passed away were actually enrolled in a hospice program.

Hospice care offers a holistic approach to medical treatment, pain control, and emotional and spiritual aid specifically catered to the needs and preferences of the dying patient. Medicare will generally cover this all-encompassing end-of-life support, whether it is provided at home or in a hospice facility, at little to no cost. This benefit includes numerous services that are typically not covered by Medicare, with over 90 percent of hospices in the US being certified by Medicare.

The Medicare Hospice Benefit covers all necessary and reasonable care to help ease the course of a terminal illness, typically offered in one's own home. This benefit includes:

• Doctor services

• Nursing care

• Medical equipment (like wheelchairs or walkers)

• Medical supplies (like bandages and catheters)

• Prescription drugs

• Hospice aide and homemaker services

• Physical and occupational therapy

• Speech-language pathology services

• Social worker services

• Dietary counseling

• Grief and loss counseling for you and your family

• Short-term inpatient care (for pain and symptom management)

• Short-term respite care

• Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team

Services that are aimed at enhancing the patient's quality of life and promoting patient  comfort are deemed suitable. This may include physical, occupational, and speech therapy, as well as chemotherapy, as long as their purpose is to provide relief rather than cure.

In addition, Medicare covers the services of a hospice physician for individuals with terminal illnesses who have not yet entered hospice care. This consultation can take place in various settings such as a hospital, nursing home, or at the patient's residence. It may involve evaluating and managing pain, as well as discussing options for care and advance care planning.

An invaluable advantage of hospice care is its inclusion of necessary medication for the terminal illness, with a maximum $5 copay. This can greatly alleviate financial strain on families, considering the high cost of pain medication.

What are the criteria for Medicare's Hospice Benefit?

To be eligible, one must have Medicare Part A coverage and be diagnosed by a physician with a life expectancy of six months or less. However, surpassing the six-month estimate does not disqualify a patient from receiving the benefit. After the initial certification, an unlimited number of 60-day periods can be granted. Patients can remain on the hospice benefit for as long as their medical team believes their life expectancy remains at six months or less.

Furthermore, the individual must complete a document indicating their choice to receive hospice care. This means choosing not to pursue curative treatment for their illness and instead opting for palliative care, focused on easing symptoms in their final days. This decision can be daunting for both patients and their loved ones. It is ultimately up to the individual, as long as they have the ability to make such a choice.

Once a patient chooses a benefit, they are not bound to it indefinitely. They can change their election and choose it again multiple times if necessary. It is worth noting that being confined to the home does not have to be a condition for receiving hospice benefits. Additionally, it is important to understand that having a "do not resuscitate" order or advance directive is not mandatory for Medicare beneficiaries seeking hospice care, despite common misconceptions.

Benefit recipients have the option to continue with their current physician or nurse practitioner, and it could be advantageous to have a separate medical expert supervising the hospice care they receive.

If the hospice beneficiary resides in a nursing home, it is important to note that the Medicare hospice benefit does not include coverage for room and board. However, if another source such as Medicaid covers this cost, Medicare will cover care for the terminal illness. It is crucial to consider whether there is a contract between the hospice and nursing home when choosing a facility for your loved one.

Contrary to popular belief, hospice care is not just for the final moments of life. Unfortunately, the average stay in a hospice lasts only 25 days. However, patients and their loved ones often express regret that they did not begin to receive it sooner. While Medicare coverage may only begin six months before death, some states allow hospices to start providing care earlier than that.