Does Medicare Cover Hospice?

When faced with a terminal illness, hospice is a great program to help preserve quality of life and assist family with tough transition ahead. According to the National Hospice and Palliative Care Organization (NHPCO), 48.2% of Medicare beneficiaries were enrolled in hospice at the time of death (2017).

With nearly 1.5 million Medicare beneficiaries utilizing hospice care every year, many are concerned with the costs involved. After all, $18.99 billion was spent on hospice care by Medicare in 2017. The great news is Medicare does cover hospice care, but there are a few things you need to know.

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What Is Hospice?

According to the Hospice Foundation of Americo (HFA), hospice is medical care for someone with a terminal illness. This special kind of care is focused on increasing the quality of life for the patient, and it can involve a team of professionals who address physical, psychosocial, and spiritual distress for not only the dying person, but the whole family.

It’s time for hospice when the patient:

Has 6 months or less to live
Is rapidly declining despite medical treatment
Is ready to live more comfortably and forego treatments aimed at prolonging life.

While many people associate hospice with cancer, today, more than half of hospice patients have another illness like late-stage heart, lung, or kidney disease or dementia. Hospice also isn’t just for the elderly – many hospice programs accept infants and children as well.

Hospice is typically provided at home or wherever the patient is most comfortable, such as a relative’s house, the hospital, or a nursing home.

Medicare Hospice Care Eligibility

As with most medical services, Medicare has a list of eligibility requirements. If you have Medicare Part A, which most do, you must meet all of these conditions:

Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (life expectancy of 6 months or less).
You accept palliative care (for comfort) instead of care to cure your illness.
You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness and related conditions.

Palliative care, provided by a specially-trained team of doctors and physicians, is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve the quality of life for the patient and the family (Get Palliative Care).

It’s important to know that when you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren't working.

What You Pay vs. What Medicare Pays for Hospice Care

As long as you have Medicare Part A, or hospital coverage, you will pay nothing for hospice care.

There are a few disclaimers, which include:

If you’re getting hospice care at a facility like a nursing home, Medicare won’t pay the room and board
If your pain relief and symptom control prescriptions aren’t covered by the hospice benefit (which is rare), you might have to pay a copay of no more than $5
You may need to pay 5% of the Medicare-approved amount for inpatient respite care.

Respite care is short-term relief for in-home hospice caregivers. Hospice respite lets the caregiver rest and recover from the daily demands of in-home care. This is oftentimes much needed, as 32% of adults say caring for an aging parent is stressful (Pew Research Center).

If your usual caregiver (like a family member) needs a rest, you can get inpatient respite care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home).

Your hospice provider will arrange respite care for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but it can only be provided on an occasional basis.

When your hospice benefit starts, Medicare won’t cover any of these:

Treatment intended to cure your terminal illness – remember that when you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren't working.
Prescription drugs to cure your illness
Care from any hospice provider that wasn’t set up by the hospice medical team
Room and board
Care you get as a hospital outpatient (like in the ER), care you get as a hospital inpatient, or ambulance transportation unless it’s arranged by your hospice team or isn’t related to your terminal illness.

What Is Covered Under the Hospice Care Medicare Benefit?

We know that hospice care is designed to improve your quality of life when you have a terminal illness. But what does Medicare consider part of hospice care?

Thankfully, Medicare published a list of services that can be included in your plan of care:

Doctor services
Nursing care
Medical equipment (think wheelchairs or walkers)
Medical supplies (think bandages or catheters)
Prescription drugs specifically for symptom control or pain relief (not to cure the terminal illness)
Hospice aide and homemaker services
Physical therapy services
Occupational therapy services
Speech-language pathology services
Social work 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

While this is a pretty exhaustive list, Medicare will cover any other typically covered service needed to manage your pain and other symptoms. As always, these services need to be recommended by your hospice team in order to be covered.

Hospice Care in Decatur, IL

There are several options for hospice care in the Decatur area. Here’s a brief look at four hospice care options in our area, including DMH Hospice, Harbor Light Hospice, Comfort Keepers®, and Heritage Operations Group.

1. DMH Hospice (Decatur Memorial Hospital)

DMH offers a hospice program that is supported by DMH professionals and trained volunteers who work together to provide compassionate care to patients and their families.

DMH Hospice care is primarily based in the home of the patient, but it’s also provided in several nursing home facilities in Decatur and surrounding areas. If symptoms aren’t manageable, short-term hospitalization can be provided at DMH.

In addition to hospice care in the home, DMH Hospice offers the Inpatient End of Life Care Program at the hospital.

DMH Hospice also continues to support the family 13 months after the patient’s death through one on one visits from the Bereavement Counselor, telephone calls and grief materials in the mail.

2. Harbor Light Hospice

Harbor Light Hospice serves many counties in Illinois, including Macon county. Their mission is to promote the access and availability of reliable end-of-life care.

The Harbor Light Hospice team can support patients and families with a variety of services during this difficult time including:

Medication administration for pain and other symptoms
On-site physician and nursing assistance
Access to all necessary medical equipment and supplies
In-home care assistance with activities of daily living (ADLs)
Training and support for family care providers
Access to support groups and counseling for family members and the patient
Nutrition counseling with an RD
Speech, physical, and occupational therapy support
Consultation with a religious or spiritual advisor
Respite care during short-term situations

In addition to Illinois, Harbor Light Hospice serves Arizona, Colorado, Indiana, Nebraska, Ohio, Oregon, Texas, and Virginia.

3. Comfort Keepers®

Comfort Keepers®, located on 1398 N Oakland Ave in Decatur, IL, offers companion care, home making services, 24-hour care, respite care, and private duty nursing. They create a custom care plan that accounts for all situations, concerns, and requirements.

Comfort Keepers® can support you and your loved one by working with a hospice agency or medical provider to fully meet the family’s care needs. They explain they will help care for your loved one as well as assist around the house and provide the family with emotional and moral support.

The Comfort Keepers® team can also help families deal with the loss and assist with tasks such as organizing personal items and moving belongings, or just simply being there to listen if family members need to talk and process their grief.

4. Heritage Operations Group

Heritage Operations Group offers end-of-life care for terminally ill seniors and their families. In addition to their trained medical staff and contracted hospice care staff, the Heritage hospice care team may include clergy, social workers, and family members.

At Heritage Health, their hospice care is designed to meet the unique needs of residents and families. Many of the Heritage communities partner with local hospice care providers and work side-by-side with specialized hospice teams. There is a Heritage Health in Mt. Zion, IL which offers Hospice and Respite Care.

Medicare And Hospice

When you’re faced with less than 6 months to live, the cost of care should be the last thing on your mind. As long as you have Medicare Part A, hospice care will cost you nothing.

In addition, many life insurance policies have riders that allow you to borrow funds when you’re terminally ill. Check with your insurance agent if you have any questions about existing life insurance or if you’re interested in adding a terminal illness rider.

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