Understanding Hospice: A Benefit Covered by Medicare and Medicaid

Dallas Hospice Care

Discussing hospice care can be difficult. Often patients and their families are reluctant to discuss the option of hospice care with the physician when confronted with the diagnosis of a terminal illness, and sometimes, physicians and clinicians do not refer to hospice until the patient is near death and the benefits are lost to the patient and loved ones. Opening the conversation with your provider on planning for end-of-life options can be so beneficial, and these conversations should always include your right to choose the agency you prefer. Also, hospice is a service covered by Medicare, Medicaid, VA benefits and most private insurance companies.

What is hospice care? Hospice is a health service based on a philosophy that you may wish to prepare for death in a safe and supportive environment, usually your own home, but it can be anywhere a person calls home. Hospice provides comfort care and symptom management so that patients enjoy quality of life, rather than pursuing curative measures. Hospice is for those who do not wish to continue to return to the hospital and wish to remain at home.

Hospice services are provided by a team of health care professionals who follow a plan of care that is unique to the patient’s diagnosis, wishes, culture and specific needs. The hospice team is typically comprised of a physician, registered nurse, social worker, home health aide, chaplain, and volunteer. The team works closely with the patient’s primary care physician to continuously re-evaluate services that may be needed. The team assists in all aspects of care for the patient and family. Following death, bereavement care is also available to family and loved ones.

The criteria for hospice eligibility are the same, regardless of the payer source – Medicare, Medicaid or your insurance company: A physician must certify that a patient has a life-limiting illness. The prognosis for living is less than six months if the disease follows its normal progression, but that does not mean the patient can only be on hospice for six months. The physician will re-evaluate the prognosis at certain intervals with home visits to ensure the patient still qualifies for hospice. The focus of care is on symptom and comfort measures rather than curative care.

It is important to discuss all options with your practitioner, and they will send an order to the hospice of your choice. Regardless of the agency you choose, under Medicare and Medicaid benefits, patients are eligible to receive all medications related to their hospice diagnosis and including new medications as the disease progresses. Medicare beneficiaries who receive hospice care are also eligible for medical equipment and supplies needed to accommodate their needs such as a hospital bed, special mattress for skin care, wheelchair, bedside commode, oxygen therapy, wound care supplies, etc. During the course of care, there may be a need for additional services that are also covered by Medicare.

When you and your family are faced with these difficult decisions, there are so many questions and concerns that need to be addressed. Take time to talk to your physician about hospice care, and the opportunity to spend final days with the comfort of knowing that you are receiving quality care in your own home, with your loved ones. Understanding your right to choose the agency you want and receiving the full benefits provided to you by Medicare, Medicaid, or other private insurances, can help ensure peace of mind.