Hospice: A Benefit Covered by Medicare and Medicaid
By Robert Smith, VNA, Collin LIVING WELL Magazine
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. Don’t be hesitant to do so. Sometimes physicians and clinicians fail to suggest hospice until the patient is near death and the benefits are lost to the patient and loved ones. Your discussion with your physician about hospice should include your right to choose the agency you prefer. Remember, hospice is a service covered by Medicare, Medicaid, and some private insurance companies.
Hospice is not giving up on life or simply choosing to die. It 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. Hospice provides comfort care and pain management so that patients enjoy quality of life during the final phase of a terminal illness.
Hospice services are provided by a team of healthcare professionals who follow a plan of care that is unique to the patient’s diagnosis 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.
Many people never realize they are eligible for hospice. The criteria is identical 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; The focus of care is on symptom and comfort measures rather than curative care.
When talking with your doctor about the possibility of hospice, you are entitled to choose any Medicare-certified hospice agency that provides services in your community. It is important for you and your loved ones to visit with a representative to know what range of services a hospice agency provides, including assistance with care outside normal business hours.
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 (medications you may already be taking that are not related to the hospice diagnosis are not covered under the Medicare benefit). This can sometimes be confusing; however, a patient’s hospice team will assist in assessing and identifying medications that are covered.
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, and oxygen therapy. 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 the crisis of a terminal illness, there are so many questions and concerns that need to be addressed. Do take time to talk to your physician about hospice care, an opportunity to spend your final days with the comfort of knowing that you are receiving quality care and are 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.
Additional information about hospice care can be obtained by contacting Director of Marketing Elaine Harrison, RN at 214-689-2661.