With a start date of October 15, open enrollment is right around the corner. It’s the two months out of the year when seniors can decide if they want their Medicare coverage through the original Medicare plan or through a private insurance company’s Advantage plan. You may have heard rumors about people getting seriously ill and needing to switch back to original Medicare for better coverage. This causes many people to ask, “Will I need to switch back to original Medicare to get good hospice coverage?” and “Will I be able to switch when the time comes?”
Medicare Advantage Plans Do Not Cover Hospice
The first thing to understand is that Medicare Advantage plans do not technically cover hospice. Under Medicare Part C rules, Medicare Advantage plans cover all the same benefits as original Medicare except hospice. When seniors with Advantage plans need hospice, it is still covered through original Medicare / Medicare Part A, regardless of whether they are using original Medicare or Medicare Advantage plans.
Do I Keep My Medicare Advantage Plans When I Am in Hospice?
Yes. People in hospice continue to receive their normal benefits from their Medicare Advantage plans, plus they start receiving an additional benefit, the hospice benefit, through original Medicare.
What Does the Hospice Benefit Cover?
Whether you are covered by original Medicare or a Medicare Advantage plan, the hospice benefit covers the same things. The hospice benefit pays 100% for services, drugs, equipment, and supplies related to the hospice diagnosis. This may include home nursing, wound care supplies, a hospital bed delivered to the home, pain medication, etc. Patients receiving hospice have no deductible to pay, no copays, and no cost sharing of any kind for covered services.
Will My Advantage Plan Premiums Go Up When I Start Hospice?
No. Even though hospice patients start receiving both Medicare Advantage benefits and an additional hospice benefit through original Medicare, the costs to Medicare Advantage beneficiaries remain the same. However, people with Advantage plans do need to keep paying their premiums, copays, and deductibles according to plan rules. Original Medicare pays 100% for hospice-related services, but all other healthcare is handled normally.
Will Hospice Shut Off My Other Healthcare Services?
Technically speaking, patients on hospice should still be able to receive healthcare not related to the hospice diagnosis. Since the hospice benefit gives the hospice agency a bundled payment for all the care related to the hospice diagnosis, Medicare will not pay for related services elsewhere. They would consider that paying twice for the same diagnosis. However, not all healthcare would be related to the hospice diagnosis. For instance, if a man receiving hospice for COPD is bitten by his cat, he could still go to his normal doctor to have the cat bite treated.
Why Have I Heard that Hospice Shuts Off Other Healthcare?
People sometimes report hearing grumbling at the doctor’s office about Medicare not covering routine care for hospice patients. This probably stems more from a billing problem than from an actual change in coverage. Doctors often report having trouble billing Medicare for covered services during a hospice episode. When doctors provide non-hospice care for hospice patients, they are supposed to put extra codes on their bills to instantly tell Medicare or the insurance company that this is not a hospice bill. It’s possible that doctors are not coding their bills correctly, that insurance/Medicare is not processing these bills correctly, or some combination of both. If a hospice patient is having trouble receiving other covered healthcare services, it may be helpful to try calling other doctors in the area to see if they have more success with this type of billing.
In short, of all the things seniors have to worry about during the open enrollment period, hospice isn’t one of them. Everyone has hospice coverage through original Medicare, even people who elect Medicare Advantage plans.