Medicare Coverage for End-of-Life Care

Question: The doctor informed me that Mom’s illness is terminal and that, if she would like, Medicare will cover her hospice care needs. How is hospice care different from normal Medicare coverage?

Answer:  Although doctors usually confront their patients’ illnesses by trying to find cures, hospice care is provided when a medical determination is made that the patient cannot be cured and is likely to pass away within the next six months. Instead of attempting to find a cure, the hospice team’s goal will be to eliminate the patient’s discomfort and pain. This type of treatment is called “palliative care.”

Terminally ill patients who are covered by Medicare Part A and have a “six month diagnosis” may choose hospice care as a treatment alternative.  This does not mean that Medicare’s hospice coverage is limited to six months. Instead, it is a manner of explaining the type of illness being confronted. Should the illness go into remission, hospice care will cease and ordinary Medicare coverage will resume. And should the illness be prolonged beyond six months, requested hospice coverage will remain.

Medicare only covers hospice care provided by an approved team that must include a physician, nurse, physical therapist and other available staff. Because Medicare’s hospice benefits do not cover the costs of room and board, many of its hospice patients receive their care at home. For them, the primary caregiver is often a family member or friend. Members of the hospice team visit at periodic intervals to make sure the patient’s needs are being met and that family, friends and volunteer caregivers are also receiving sufficient support.

Specific hospice services covered by Medicare include:

• Medical services performed by a physician.

• Nursing care provided by or under the supervision of a registered nurse.

• Physical therapy, occupational therapy and speech language pathology services that enable the patient to maintain daily living activities and basic functional skills.

• Drugs and other similar products prescribed for pain relief and symptom control with a Medicare co-payment fee of no more than $5 for each prescription.

• Respite care or short-term inpatient care for the patient. This type of care is offered as a temporary relief for family members or other care providers. Should the hospice team deem it necessary, the patient may receive unlimited periods of respite care in a Medicare-approved hospital or skilled nursing facility for up to five consecutive days, with a daily co-payment fee of 5%.

• Bereavement counseling for family and friends.

For many people, end-of-life issues are very difficult to confront and discuss.  For more information, contact H.E.L.P. at 310-533-1949.