As we age, our healthcare needs increase, and so does our reliance on Medicare. In the U.S., nearly 2 million people rely on Medicare for their hospice benefits every year. In fact, Medicare spends about $22 billion annually on hospice care. So, what does it mean for you? How does hospice work, and what are the expenses involved?
Today, we will be diving into hospice and Medicare. To fully understand how Medicare and hospice work together, we had a conversation with Russ Rogers, a renowned authority in the field of hospice and palliative care.
Hospice vs Palliative Care
Let’s start by differentiating between hospice and palliative care. It’s a confusing distinction for many people, but it’s important to remember that hospice care is palliative care, but palliative care isn’t hospice care. Let’s explain.
Palliative care is a milder version of hospice care specifically designed to help improve a person’s quality of life. Those receiving palliative care may meet hospice criteria but are not yet ready to acknowledge that they are approaching the end of their life.
With palliative care, patients have access to a team of healthcare professionals, although the level of care provided is not as intensive as in hospice. Medicare introduced palliative care around 4-5 years ago to help individuals come to terms with their mortality without having to explicitly acknowledge their imminent passing.
For full hospice benefits under the Medicare program, however, a terminal diagnosis with an expected lifespan of six months or less is required.
Does Medicare Cover Hospice?
Medicare covers hospice but qualifying for those benefits can be murky. Many believe the misconception that hospice care is only for those in their final days, but in reality, it is intended for end-of-life care. To receive hospice coverage from Medicare, the patient must be in a state of gradual decline, which can range from a few days to a year and a half or even longer depending on their specific health condition.
Despite hospice being designed as a six-month benefit, it’s not unusual for people to still be receiving hospice care beyond that period. About 11% of people improve and come off hospice service because they receive such a high level of daily care and attention.
Hospice care can also be provided in various settings, including your home, a community facility, or even a skilled nursing facility. Many individuals prefer to spend their final days in the comfort of their own homes, but there are situations where this may not be feasible. In these instances, hospice care can seamlessly transition to a care facility to accommodate patient needs and preferences.
In the realm of hospice care, a collaborative and diverse team of healthcare professionals is brought together to provide comprehensive support. This team comprises a physician, a case manager who is a registered nurse, a compassionate chaplain, a dedicated social worker, a caring hospice aide, and a compassionate volunteer. Together, they work harmoniously to ensure every aspect of the patient’s physical, emotional, and spiritual well-being is addressed with utmost care and expertise.
Does Medicare Cover Palliative Care?
We know that Medicare covers hospice care, but what about other types of palliative care? Similar to hospice, Medicare will cover many types of palliative care such as inpatient and outpatient assistance and mental health counseling.
Palliative Care vs Long-Term Care
Palliative care can sometimes lead people to incorrectly believe it’s the same as long-term care. Long-term care focuses on assisting individuals with chronic conditions or disabilities in performing daily living activities. Medicare typically does not cover long-term care, with some exceptions for skilled nursing care under specific conditions. However, it is possible if your chronic disease deteriorates enough, your treatment could later be covered as palliative or even hospice care.
How to Choose a Hospice Provider
Now let’s look at the financial side of hospice care. A considerable advantage of hospice care is that it’s a part of your Medicare benefit and is 100% covered by Medicare.
With over 5000 hospice providers in the U.S., selecting the right one can be overwhelming. What differentiates one hospice provider from another is their focus. For instance, Russ’s team at Missouri Palliative and Hospice Care focuses on veteran needs and their hospice services. They have undergone extensive training to provide veterans with the unique care they require during their end of life and implement specialized programs to honor veterans throughout the year.
When choosing a hospice provider, some pertinent questions to ask include
- What is your nurse-to-patient ratio?
- How much time do your healthcare providers spend with each patient?
- Do you provide wound care (a service not required under the Medicare hospice benefit but is highly beneficial to certain patients)?
It’s also advisable to check their ratings on Google and Medicare websites to understand their credibility and overall bedside manner.
Honoring Life’s Final Chapter with Grace and Compassion
Embracing the end of life with dignity and care is a profound and deeply personal journey. Hospice care can provide the support and guidance needed to navigate this territory, ensuring that the patient’s final days are filled with comfort, respect, and love. By understanding the benefits of hospice care and how Medicare works to cover it, you can prepare for what lies ahead by choosing the right hospice provider.
Part of preparing for what lies ahead starts with the right Medicare plan. If you need help exploring your Medicare options schedule an appointment with a licensed agent or give us a call for quick inquiries about Medicare. Want to learn more about what Medicare covers? Enroll in our virtual and free Medicare Essentials Workshop.