If you’re like many people in Cleveland, Ohio, you may not know that Medicare offers complete coverage for hospice care at home.
The Medicare hospice benefit covers everything a terminally ill individual needs toward the end of life, including medication, medical equipment and medical supplies. Skilled nursing services are also covered, as are physical and occupational therapy, complementary therapies, counseling services and bereavement care. Medicare supports a holistic approach to care, addressing not only physical symptoms but also the emotional and spiritual concerns of the patient and the family.
While not everyone will need hospice services in their lifetime, understanding the qualification requirements for Medicare coverage is of great importance. Here’s what you need to know about eligibility for hospice care at home.
Medicare Hospice Eligibility Criteria
For the services listed above to be covered under the Medicare hospice benefit, patients must meet specific criteria. Aside from enrollment in Medicare Part A, the main requirements are:
- Diagnosis of a terminal illness: The patient’s condition must be severe and unlikely to improve, as curative treatments have proven to be ineffective. The diagnosis must come from a qualified medical practitioner.
- Prognosis of six months or less: The patient’s physician and the hospice agency medical director must certify that the individual is unlikely to live longer than six months if their illness progresses as expected.
- Agreeing to comfort care: The patient must agree to forgo any further curative efforts and focus on comfort care instead. With hospice care at home, the goal isn’t to seek a cure – it’s to improve quality of life.
In addition, to access Medicare hospice coverage, the patient must choose a Cleveland provider that is certified by Medicare and licensed by the Bureau of Regulatory Operations at the Ohio Department of Health. Otherwise, services won’t be covered.
Medicare Hospice Coverage Periods
Although Medicare requires a prognosis of six months or less for hospice care at home to begin, coverage doesn’t stop after six months. The real-world application is more adaptable:
- Initial coverage periods: At the start, the Medicare hospice benefit covers two consecutive 90-day periods of care. In other words, once a patient accepts hospice care at home, they receive services for an initial period of 90 days. If their condition warrants continued care, a second 90-day benefit period follows.
- Subsequent coverage periods: Under Medicare, anyone eligible for hospice care at home can continue to receive services for an unlimited number of 60-day periods after the initial 90-day periods come to an end. However, the hospice medical director must re-certify the patient for each 60-day benefit period.
In the event a patient’s health improves and they are no longer considered to be terminally ill, Medicare hospice coverage ends. As such, the patient is discharged from the hospice program – but if they meet the eligibility criteria at any point in the future, services can resume.
Limitations of the Medicare Benefit
The Medicare hospice benefit covers nearly all of the costs of services related to a patient’s terminal illness, but there are a few exceptions. Cleveland families can expect to pay for the following:
- Curative treatment: Medicare doesn’t cover life-extending medical treatments or therapies intended to provide a cure for a terminal illness.
- Outside care: All of the care a patient needs for a terminal illness must be provided or arranged by their chosen hospice care provider.
- Unrelated conditions: Any services or support for health problems that aren’t related to the patient’s terminal illness aren’t covered.
- Room and board: The cost of staying at a nursing home isn’t covered by Medicare unless necessary for inpatient or respite care.
- Emergency care: Under Medicare, ambulance and emergency room services are only covered when arranged by the hospice care provider.
While the above information is accurate as to the terms of the Medicare hospice benefit, some patients in Cleveland may have coverage for these services. For more information, families can contact their chosen hospice care provider.
When to Consider Hospice Care
When a terminally ill individual has a projected six months or less left to live, hospice care at home may be the right choice. However, diseases can follow different paths of progression, so it’s not always clear when the end of life is near. As such, watching for common end-of-life signs is important with a terminal diagnosis. If a terminally ill loved one is experiencing any of the following, hospice services may be appropriate:
- Uncontrollable pain, nausea or shortness of breath
- Recurrent infections or continual symptom flare-ups
- Regular hospital stays or emergency room visits
- Decreased alertness and more time spent sleeping
- Weight loss due to lack of interest in eating and drinking
- Difficulty managing urinary or bowel incontinence
Mental and emotional concerns can also indicate a need for hospice services. If a loved one with a terminal illness is withdrawing from family and friends, having trouble following conversations, making out-of-character requests, displaying signs of confusion or developing delusions, hospice care at home may be appropriate.
Get the Care You Need with Suncrest Hospice
Do you believe a loved one meets the criteria to take advantage of the Medicare hospice benefit? In Cleveland, Suncrest is a trusted leader in end-of-life care. To arrange for a free, no-obligation consultation to discuss hospice care at home, contact us today.
