Many people in Tulsa, Oklahoma, struggle with terminal illnesses, not realizing that hospice care is available – or that services are covered under the Medicare hospice benefit.
Here at Suncrest, we recognize that healthcare coverage can be rather confusing, but understanding how hospice works is essential. Everyone who qualifies should give thought to entering hospice, as it allows for a more comfortable and fulfilling end-of-life experience. But the fact that most families pay little to nothing for hospice services isn’t well-known, and we’d like that to change.
With that in mind, we’re diving into the Medicare hospice benefit and how it helps ensure that hospice care is within financial reach. Read on to find out what is and isn’t covered under Medicare.
What is Hospice Care?
Hospice isn’t a place, and it isn’t about dying. It’s a plan of care for terminally ill individuals who are nearing the end of life, and choosing hospice care at the right time, patients are able to make the most of every remaining moment. Consider the following facts:
- The focus is on comfort, and hospice care providers do all they can to help patients live as well as possible throughout the final stages of illness.
- While in-patient services are available for those in need, care typically takes place in the individual’s home or wherever they currently reside.
- Services include physical care, emotional, social and spiritual support, and complementary therapies like massage, art, music and pet therapy.
- Medications and medical supplies to manage the terminal illness are provided, as is any durable medical equipment needed for in-home care.
The Medicare hospice benefit covers everything above when it concerns the patient’s terminal illness or related conditions, even if they choose to remain in a Medicare Advantage Plan. Upon entering hospice, Original Medicare continues to cover services for unrelated health problems, but the individual is responsible for any coinsurance and deductibles.
Who Is Eligible for the Medicare Hospice Benefit?
Contrary to what many people think, hospice care isn’t just for cancer patients. Anyone who has an illness that cannot be cured might qualify, including individuals with the following:
- Alzheimer’s disease
- Cardiac disease
- COPD
- Emphysema
- Kidney disease
- Multiple sclerosis
- Parkinson’s disease
- Rheumatoid arthritis
To be eligible for the Medicare hospice benefit, a patient must be certified as terminally ill by a physician. In addition, they must be:
- Enrolled in Medicare Part A
- Expected to live for six months or less, assuming the illness runs its usual course
- Willing to forgo any further curative treatment in favor of living more comfortably
Only the patient’s own doctor, if they have one, or a Tulsa hospice physician can certify that someone has a terminal illness and a limited lifespan. Also, the decision to accept hospice care isn’t irreversible – every patient has the right to change their mind and restart the search for a cure.
What Does the Medicare Hospice Benefit Cover?
Tulsa hospice care providers offer free, no-obligation consultations, and anyone can reach out to discuss services and care options. Going this route is a good way to get an understanding of what’s covered under the Medicare hospice benefit, but as a general rule, the following services come at no cost to patients or their families:
- Physician services
- Skilled nursing care
- Physical and occupational therapy
- Speech-language pathology services
- Social worker and volunteer services
- Grief and loss counseling for the family
- Short-term continuous home care to cope with medical crises
- General inpatient care when a crisis cannot be managed at home
- Respite care to allow family caregivers to take a much-needed break
A word of note: Medicare covers the services listed here as well as any other services recommended by the hospice team, but only when provided by a Medicare-approved care agency.
What Isn’t Covered Under the Medicare Hospice Benefit?
Once an individual chooses to enter hospice care, Medicare covers everything related to their terminal illness and related conditions. As for what isn’t covered under the Medicare hospice benefit, that includes all of the following:
- Curative treatments and procedures
- Care not arranged for by the hospice team
- Room and board for inpatient or respite care, unless medically necessary
Prescription medications that are unrelated to the terminal illness aren’t part of the hospice benefit, either. They might be covered under Medicare’s drug (Part D) plan, but patients may have to pay a copay.
How Do Medicare Advantage Plans Handle Hospice Care?
Original Medicare steps in to cover the costs of everything related to an individual’s terminal illness – even if they choose to remain in a Medicare Advantage Plan. However, as long as they continue to pay their plan premiums, they have coverage for the following:
- Extra services, like vision and dental care, that are medically necessary
- Treatments and services for health issues unrelated to the terminal illness
- Prescriptions for other medical concerns, if the plan includes drug coverage
For anyone who belongs to a Medicare Advantage Plan, the first step to starting hospice care is to contact the plan. Under the current guidelines, the plan must help locate a Medicare-approved hospice care provider in the area.
Do you have questions about the Medicare hospice benefit? Or would you like information on other ways to cover the costs of hospice care in Tulsa, Oklahoma? Either way, the professional team at Suncrest would be happy to be of service. Contact us today!
