Hospice: A Benefit Covered by Medicare and Medicaid––Visiting Nurse Association

Hospice: A Benefit Covered by Medicare and Medicaid

By Robert Smith, Visiting Nurse Association, Denton and Collin County LIVING WELL Magazines

Oftentimes patients and their families are reluctant to discuss hospice care with the physician when confronted with the diagnosis of a terminal illness. Hospice is not giving up on life and simply choosing to die. Hospice provides comfort care and pain management so that patients enjoy quality of life during the final phase of a terminal illness.

Many patients never realize, though, that they are eligible for hospice care. Hospice is a covered benefit of Medicare, Medicaid, and most private insurance.

Sometimes physicians fail to suggest hospice until the patient is near death and these benefits are lost to the patient and family. Discussions with the physician about hospice care should also include a patient’s right to choose the hospice agency he or she wants to provide the care.

Hospice services are provided by a team of healthcare professionals typically comprised of a physician, registered nurse, social worker, home health aide, chaplain, and respite care volunteer. The team works closely with the patient’s primary care physician to continuously reevaluate services that may be needed.  The team assists in all aspects of care for the patient and family. Bereavement support is also available to the family and other loved ones following the death of the patient.

Medicare beneficiaries are eligible to receive needed medical equipment and supplies. Patients under Medicare also qualify to receive medications related to the hospice diagnosis, including additional medications as the disease progresses.  Other services that may be needed during the course of care are covered by Medicare, too.

The criteria to receive hospice care are identical regardless of the payer source––Medicare, Medicaid, or private insurance. A physician must certify that a patient has a life-limiting illness, that the prognosis for living is less than six months if the disease follows its normal progression, and the focus of treatment is on symptom and comfort measures rather than curative care.

When a patient and family are considering hospice care, it is important to discuss with a representative of a prospective agency the range of services it provides, including assistance outside normal business hours.

Understanding the right to choose a hospice agency and receiving the full benefits provided by Medicare, Medicaid, and private insurance will also help ensure that patients receive quality care.

Robert Smith is director of public relations for Visiting Nurse Association. For additional information about hospice care, call the Visiting Nurse Association at 214-689-0000 or online at vnatexas.org.