While both hospice and palliative care are for people with serious illnesses, they differ in the kind of care they offer. Let’s take a look at what you need to know about the differences between them and how Medicare covers them.
Hospice Care
Hospice care is for people who have received a diagnosis of a terminal illness and have fewer than six months to live. It is a comprehensive approach that focuses on reducing suffering and improving quality of life.
Eligibility for Hospice
For Medicare to cover hospice care, the patient must meet these requirements:
- A doctor must certify that the patient has a diagnosis for a terminal illness and has a life expectancy of less than six months. If the patient’s illness extends beyond six months, the doctor can recertify the patient.
- The patient must sign a statement that he or she is choosing hospice care and agrees to accept no curative treatments meant to treat or eliminate the disease or condition. The patient may receive comfort care, such as medications for pain, oxygen, or blood transfusions.
Patients who qualify for hospice care will receive two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. Patients have the right to change their hospice provider once during each benefit period.
Care Team
A specially trained team of hospice professionals consisting of nurses, doctors, therapists, social workers, and chaplains will take over the patient’s care. Most hospice care is provided in the home, but hospitals, hospices, assisted living facilities, and long-term care facilities can also provide this care.
The hospice team will set up a plan of care. This may include doctor and nursing care, medications, medical equipment and supplies, speech, occupational, and physical therapy, short-term respite care, social work, and grief support for the patient and their family.
The Medicare hospice benefit will only cover services that the hospice care team recommends and arranges. This includes any emergency room visits and inpatient hospital stays related to the illness.
Medicare Coverage
Once a patient has elected to receive hospice care, they have coverage under Original Medicare Part A, even if they have a Medicare Advantage plan. Patients will pay nothing for hospice care as long as they receive the care from a Medicare-approved hospice provider. Patients will pay up to $5 for each prescription related to their hospice care. Those who receive respite care will pay 5% of the Medicare-approved amount for inpatient respite care.
A patient can choose to stop hospice care at any time and resume curative medical treatments for his or her diagnosis. Patients must sign a form that includes an end date for hospice care. At this point, hospice benefits will cease and normal Medicare benefits will resume.
Palliative Care
Palliative care is available to patients who have received a diagnosis for a serious illness and who want to continue to pursue treatment to preserve and prolong their lives.
Palliative Care Eligibility
Patients are eligible for palliative care as long as they have a life-threatening or life-limiting illness. Care may be intermittent and on an as-needed basis, depending on the symptoms. It will continue as long as the patient has a serious illness, until the patient enters hospice care, or until the patient no longer needs palliative care.
Some examples of conditions that may require palliative care include cancer, ALS, MS, COPD, congestive heart failure, HIV/AIDS, and Alzheimer’s disease.
Palliative Care Team
A palliative care team does not replace the patient’s current doctors. The team will work in conjunction with the current doctors to help with pain management, symptom control, and treatment side effects. The team can also help with navigating treatment options, mental health, and emotional and spiritual needs as well as financial matters. They may provide care in the patient’s home, a hospital, a nursing home, or a palliative care clinic.
Medicare Coverage
Since Medicare doesn’t distinguish palliative care from other covered services, it is paid like any other doctor or service under the patient’s Medicare plan. This means any appropriate Part A and B deductibles and copays will apply. The palliative care provider must be Medicare-approved. Medicare Advantage enrollees should check with their plan to make sure it covers the palliative care provider.
How You Can Help
Experiencing a serious illness is a stressful time for your clients and their families. By understanding hospice and palliative care, you can offer valuable guidance to help clients make informed decisions about their care.
The team at Western Asset Protection is dedicated to supporting you. Contact us today.