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Taking Care of Mom and Dad: Hospice and Medicare

Hospice coverage is widely available. It's provided by Medicare nationwide, by Medicaid in 39 states and by most private insurance providers. If your parent is not covered by Medicare or any other health insurance, the first thing hospice will do is assist you and your parents in finding out whether he or she is eligible for any coverage they may not be aware of. Barring this, most hospices will provide for anyone who cannot pay using money raised from the community or from memorial or foundation gifts.

For those covered by Medicare, hospice is available as a benefit under Medicare Hospital Insurance (Part A). Medicare beneficiaries who choose hospice care receive non-curative medical and support services for their terminal illness.

To be eligible, they must be certified by a physician to be terminally ill with a life expectancy of six months or less. While they no longer receive treatment toward a cure, they require close medical and supportive care that a hospice can provide. Hospice care under Medicare includes both home care and inpatient care, when needed, and a variety of services not otherwise covered by Medicare.

Hospice focuses on care, not cure. Emphasis is on helping the person to make the most of each hour and each day of remaining life by providing comfort and relief from pain.

Medicare considers hospice a program of care delivered in a person's home by an approved provider. Reasonable and necessary medical services are furnished under a plan of care established by the beneficiary's physician and hospice team. Specifically, Medicare covers the following expenses under its version of hospice care:

  • physicians' services;
  • nursing care (intermittent with 24-hour on call);
  • medical appliances related to the terminal illness;
  • outpatient drugs for symptom management and pain relief;
  • short-term acute inpatient care, including respite care;
  • home health aide and homemaker services;
  • physical therapy, occupational therapy and speech/language pathology services;
  • medical social services; and
  • counseling, including dietary and spiritual counseling.
  • That said, hospice care is available under Medicare only if:
  • The patient is eligible for Medicare Hospital Insurance (Part A);
  • The patient's doctor and the hospice medical director certify that the patient is terminally ill with six months or less to live if the disease runs its expected course;
  • The patient signs a statement choosing hospice care instead of standard Medicare benefits for the terminal illness; and
  • The patient receives care from a Medicare-approved hospice program.

Hospice care can be provided by an agency or organization that is primarily engaged in furnishing services to terminally ill individuals and their families. To receive Medicare payment, the agency or organization must be approved by Medicare to provide hospice services.

Approval for hospice is required even if the provider is already approved by Medicare to provide other services. Patients can find out whether a hospice program is approved by Medicare by asking their physician or checking with the organization offering the program. This information also is available from local Social Security offices.

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