How Long Will Medicare Pay for Hospice Care

On This Page

• Understanding Hospice Care

• Eligibility Criteria

• Duration of Medicare Hospice Care

• Available Services 

• Limitations and Exclusions

• Coverage Phases

• Financing 

• Ensuring Comfort and Care for Your Loved One

Managing a terminal disease is never easy, and it can be especially difficult when it affects a loved one. Making an informed decision is more difficult when one has the necessary information on terminal illnesses without comprehension. During this time, Medicare may offer a great deal of assistance to people and families. Giving your loved one 24/7 care, comfort, and dignity is essential during this time. Stress related to money, with questions like how long will Medicare pay for hospice care, can be reduced by being aware of the requirements under Medicare's hospice program, including coverage and length. Learn the facts about hospice care, Medicare, and how to begin the process. 

Understanding Medicare and Hospice Care

Most people just tend to think of palliative care when talking about hospice care. 

Hospice care provides a personalized avenue to end-of-life care, where enhancing quality of life and pain alleviation is the priority. This form of care is rooted in a holistic philosophy; addressing the physical, emotional, and spiritual needs of your cherished one, along with your family.

Medicare and hospice care have been involved for many decades since the importance of compassionate end-of-life care was recognized in the 1980s. Medicare hospice benefits were established in 1982, and since then, it has grown significantly. Today, it offers a wide range of services designed to support patients and families through terminal illnesses and end-of-life care. Questions such as, ‘How long will Medicare pay for hospice care’ have arisen as Medicare has specific criteria and conditions for an individual to qualify for hospice care. 

Eligibility Criteria 

When it comes to Medicare and hospice care, an individual must meet specific eligibility criteria. A critical requirement is a terminal illness prognosis, where the life expectancy has been given of six months or less if the disease follows its natural course. This prognosis is then evaluated by physicians based on clinical assessments and medical evidence.

Individuals must also be enrolled in Medicare Part A and agree to forego curative treatment for their terminal illness while receiving hospice care. This simply means that an individual desires comfort and care over curative treatment. 

Duration of Medicare Hospice Care

Once your loved one goes for Medicare and hospice care, it’s important to know how long this care can be given. Hospice care under Medicare is provided in certification periods, where each period lasts up to 90 days. At the end of each period, patients have to go through a recertification process. This determines continued eligibility for hospice benefits under Medicare. It can involve reevaluation of the patient’s medical condition and prognosis by the hospice medical team.

Understanding these forms of care can be complicated, but it’s important to know that hospice benefits can be extended beyond the initial 90-day period. If your loved one’s condition remains terminal, extensions can be granted. Continuing recertifications guarantee continuity of care for your loved one, especially if they are nearing the end of life. 

Services Available 

Numerous services are associated with hospice care and Medicare. Their goal is to meet your loved ones' and those close to them's physical, emotional, and spiritual needs. Physician services, all-inclusive nursing care, prescription drugs, and medical equipment specific to the terminal illness are among the services that may be provided. It may also involve grieving services for surviving loved ones, counseling, and spiritual support. It may also involve providing caregivers with respite care.

As Medicare covers a large range of supportive care services, they are primarily aimed at enhancing comfort and quality of life for patients and their families. These services are designed to enhance comfort, alleviate symptoms, and promote dignity during life’s final stages.

• Physician Services: Think of Earth without the Sun; without one, the other wouldn't know what to do. Similarly, physicians play an important role in coordinating and managing the overall care of patients under hospice care.  They work with the patient’s primary care physician and other hospice team members to oversee the patient’s individualized care plan. 

• Nursing Care: Just like a house needs a good foundation, hospice care needs nurses. They are the cornerstone of Medicare and hospice care. They provide round-the-clock support and monitor patients with complex medical needs. From administering medications to providing wound care, they provide holistic support to patients and families. 

• Medications and Medical Equipment: Medicare hospice care benefits cover all medications related to the terminal illness and those necessary for symptom management and pain relief. It is also related to equipment required to alleviate pain, manage symptoms, and improve the patient’s quality of life. 

• Counseling and Spiritual Support: It's critical to attend to patients' and families' emotional, psychological, and spiritual needs during trying times. Social workers, counselors with licenses, and other professionals offer treatment, uncomfortable talk facilitation, emotional support, and spiritual advice during bereavement. 

• Respite Care: Carer comfort and assistance are offered through respite care to anyone who may require a temporary break from their caring duties. Up to five days of respite care are covered by Medicare hospice care benefits. This makes it possible for primary carers to take time off without compromising the high-quality, individualized care that patients get in their most comfortable setting. 

• Last Services: Medicare benefits extend to provide bereavement support to surviving loved ones. This can include individual or group counseling, support groups, and assistance with funeral planning and memorial services. These services help families navigate the grieving process and cope with the loss of their loved one in a supportive and compassionate environment. 

Limitations and Exclusions

While Medicare and hospice care cover most essential services, there can be certain limitations to keep in mind. These limitations include services that are not covered under Medicare hospice benefits.

Medicare and hospice care do not fund curative treatments or services. These encompass any medical interventions meant to extend life or address ailments unconnected to the end-stage sickness. Examples of non-covered services can include chemotherapy (for cancer), dialysis (for end-stage renal disease), or other unrelated surgeries. It is important for patients and their loved ones to discuss the scope of covered services with their hospice team to better understand what is included in the hospice care program.

Patients can be discharged from hospice care if their condition improves or stabilizes to a point where they no longer meet the eligibility criteria for Medicare and hospice care. Patients may have the option to go for curative treatments or opt out of hospice care for personal or religious reasons. However, discharge doesn’t necessarily mean that individuals won’t be able to re-enroll in hospice care if their condition declines.

Medicare and hospice care are designed to support individuals dealing with a terminal illness, along with supporting their families. Coverage under this program can cease if the patient’s condition no longer meets the eligibility criteria. Patients can transition to other Medicare benefits to continue receiving necessary medical care and support.

While hospice providers may offer guidance and support for advance care planning, specific legal documents, such as advance directives or living wills may need to be completed separately and may not be covered under Medicare hospice benefits. 

Coverage Phases

Medicare hospice benefits are structured into different coverage phases, from the initial coverage period to following extensions. During the initial coverage period, your loved one can receive hospice care for up to 90 days. There is an option to extend benefits through recertification.

If a patient exceeds the initial 90-day period, they begin the subsequent benefits period. This continues until the patient’s condition no longer meets the established criteria for hospice care. It can also halt when the patient chooses to discontinue hospice services. 

Financing of Medicare Hospice Care

How long will Medicare pay for hospice care is a common question for those who have never dealt with hospice care. The inner workings of Medicare ensure that no patient needing hospice care has to worry about payment plans. Medicare directly reimburses hospice providers for the services delivered to eligible patients.

Medicare reimburses hospice providers through a per diem payment structure. This means that providers receive a fixed daily rate for each day a patient is enrolled in hospice care. This rate is determined by Medicare and can vary depending on the level of care provided. There are different established rates for routine home care, continuous care, and inpatient respite care. These rates are intended to cover the costs needed to provide comprehensive hospice services, which can include medical care, counseling, support services, and more.

While Medicare benefits cover most, if not all of the hospice-related expenses, it is important to check whether any other expenses are being shared. This usually relates to medications. If you are not covered under Medicare, Medicaid also provides hospice care with zero out-of-pocket costs. Some private insurers may also offer hospice care under their coverage. 

Ensuring Comfort and Care for Your Loved One

Understanding the duration, coverage, and more about Medicare and hospice care is essential when you or a loved one is facing a terminal illness. From learning how long will medicare pay for hospice care to the services available, knowing all the facets of both kinds of care can help you make the best decision for all parties involved.

At A & H Hospice, we aim to empower patients and caregivers to make informed decisions about their care options. Our compassionate hospice team understands the challenges of terminal illness, and we believe that with the right care, patients will experience greater happiness, peace, and an enhanced quality of life. Call 818-751-0700 to learn more about our personalized services within Southern California.