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Understanding Medicare's Hospice Benefit

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 can be extremely helpful to both a terminally ill individual and his or her family, but it is little understood and underutilized. Understanding what is offered ahead of time may help Medicare beneficiaries and their families make the difficult decision to choose hospice if the time comes.

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

To qualify for Medicare's hospice benefit, a beneficiary must be entitled to Medicare Part A, and 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 agree to give up any treatment to cure their illness and elect to receive only palliative care. This can seem overwhelming, but beneficiaries can also change their minds at any time. It's possible to revoke the benefit and re-elect it later, and to do so as often as needed.

Medicare will cover any care that is reasonable and necessary for easing the course of a terminal illness. Hospice nurses and doctors are on call 24 hours a day, seven days a week to give beneficiaries support and care when needed. Services are usually provided in the home. The Medicare hospice benefit offers:

  • 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 services
  • Spiritual care
  • Volunteer participation
  • Bereavement services

Services are considered appropriate if they are aimed at improving the beneficiary's life and making him or her more comfortable. However, 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 those for symptom control or pain relief
  • Care from a provider that wasn't aranged by the hospice team, although the beneficiary can choose to have his or her regular doctor serve as the attending medical professional
  • Room and board. If the beneficiary is in a nursing home, hospice will not pay for room and board 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 arranged by the hospice team. The beneficiary can use regular Medicare to pay for any treatment not related to the beneficiary's terminal illness.

Medicare now has a Hospice Compare site that allows patients or their families to evaluate hospice providers according to several criteria. Visit the site at: https://www.medicare.gov/hospicecompare/

To download Medicare's booklet on the hospice benefit, go to: https://www.medicare.gov/Pubs/pdf/02154-Medicare-Hospice-Benefits.PDF

For further guidance on applying for Medicare hospice benefits, you should talk to a lawyer experienced in Estate Planning. If you would like to speak to one of our experienced Estate Planning attorneys in western Massachusetts or southern Vermont, call us at (413) 663-3200. Donovan O'Connor & Dodig, LLP has offices in North Adams and Pittsfield Massachusetts and Bennington, Vermont.

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