What Hospice Pays For
Without proper support, the time in which families need hospice can be stressful, with multiple unusual challenges that will need to be managed. Fortunately, Medicare has bundled a hospice benefit that gets families the support and guidance they need, usually in the comfort of home. Under original Medicare, hospice is a bundled service that pays for virtually all care related to the hospice diagnosis.
What Hospice Pays for with Medicare Advantage
If you have Medicare Advantage instead of original Medicare, in most instances, your coverage will switch over to original Medicare should you need hospice. Therefore, most people receiving hospice have the same coverage. However, an increasing number of Medicare Advantage plans do not switch you over to original Medicare for hospice. Medicare Advantage plans are private insurance plans that rebundle your Medicare benefits. In these cases, you may or may not have the same coverage as most people.
Original Medicare Pays 100% of Allowable Charges
There are some instances where the rules refer to certain co-pays. However, in practice, most Medicare-certified hospice providers accept Medicare’s reimbursement as payment in full. In most cases, patients in hospice need not worry about meeting a deductible, having a co-pay, or any cost sharing of any kind for the services and products provided by or through the hospice agency.
What Hospice Pays For
The primary service in hospice is home nursing to help with preparation, rest, comfort, and symptom management. However, original Medicare covers a broad range of services, equipment, and medication under the one hospice benefit.
- Aide service for support with activities of daily living such as bathing, grooming, medication reminders, and light housekeeping. However, not all hospices routinely provide services from hospice aides.
- Volunteer coordination so volunteers can provide companionship and support with activities of daily living such as running errands or helping around the house. Many hospices also coordinate chaplain services. Hospice volunteerism can also include specific programs such as music therapy programs or comfort dogs.
- Therapies: This is primarily physical therapy, occupational therapy, and speech therapy for palliative care. However, should an agency choose to provide other similar services such as respiratory therapy or dietitian services, these would be included in the hospice benefit.
- Diagnosis-related medications. Hospice would not pay for all a patient’s medications, but it would pay for the medications related to the hospice diagnosis.
- Diagnosis-related supplies such as wound care supplies, catheters, etc.
- Diagnosis-related equipment such as hospital beds, bedside commodes, walkers, etc.
- Bereavement support: Care doesn’t end after a patient passes. Hospice stays in touch with spouses and close family members and provides bereavement support for up to six months.
Hospice Pays for Six Months of Care and More If Needed
Most patients only receive a few days or weeks of hospice. Experts recommend three months or more in hospice. This is the timeframe most associated with optimal pain and symptom control at the end of life and with patient/family satisfaction. People qualify for hospice when their life expectancy is six months or less. Fortunately, hospice will pay for more than six months of care. If a patient continues to qualify for care at the end of six months, care can continue.
Hospice Pays for Four Levels of Care
1. Intermittent Home Care
Intermittent home care refers to routine care delivered through regularly scheduled visits. Nurses, therapists, and aides may visit a few times per week, with each visit often lasting less than an hour.
2. Continuous Care
Hospice may also provide home nursing for hours at a time, and even overnight. This is one way that hospice providers attend to patient needs when intermittent care is not enough. If a patient’s symptoms are out of control, a nurse may stay in the home for hours until the symptoms are managed. Also, if a patient is actively dying and the family needs support, a hospice nurse may stay overnight. Not all families and patients need continuous care during this time. In fact, hospice can prepare most families for the passing of a loved one.
3. Inpatient Respite
Caring for a loved one with high personal care needs takes a physical and emotional toll on the caregiver. On occasion, the family caregiver will need more of a break than that provided by the visits of nurses, aides, and volunteers. In these cases, the hospice provider can check a patient into a 24-hour personal care home that is staffed for hospice patients.
4. General Inpatient Care
If a hospice patient has a medical need where inpatient treatment would be more appropriate than home nursing, patients can always be admitted to a hospital or nursing home of their choice. If the medical need is related to the hospice diagnosis, the hospice benefit will continue to pay the bills. Other medical needs would be covered as normal.
As you can see, Medicare has created a comprehensive hospice benefit delivered almost seamlessly through your chosen Medicare-certified hospice agency. If you or someone you care for may benefit from hospice services, please contact a hospice agency near you.