By Betty Berry, Tuesday, March 2, 2010 Q: I’ve read that one of the benefits under Medicare coverage is hospice care. Can you explain exactly what hospice care is and does that replace regular Medicare benefits?
A: Hospice is a type of care for the terminally ill.
The focus of hospice care is comfort and pain relief rather than treatment of the disease itself.
Those qualifying for hospice care can obtain medical and support services including nursing care, medical social services, doctor services, counseling and homemaker services.
Medical equipment such as wheelchairs, walkers, hospital beds and medical supplies including bandages and catheters are included as well as drugs for symptom control and pain relief.
Depending on the patient’s condition, hospice care can be provided in a hospice facility, hospital, nursing home or in the comfort of the patient’s own home surrounded by the family.
For a hospice patient there is a team of people who help provide the needed care.
The patient’s physician and the hospice provider set up a plan of care that meets the patient’s needs.
A team of people including the patient’s family, personal physician, nurses, social workers, clergy and trained volunteers share responsibility to make the plan work.
Hospice care is covered by Medicare Part A.
To be eligible for hospice benefits the patient must be enrolled in Medicare Part A, and his or her doctor and the director of the hospice team must certify that the patient is terminally ill and probably has less than six months to live.
The patient must sign a statement choosing hospice care instead of regular Medicare covered benefits for the terminal illness, and the care must be provided by a Medicare-approved hospice provider.
With the exception of a $5 co-payment for each prescription drug required for pain relief or symptom control, Medicare will pay for the hospice care, however, Medicare does not cover the cost of room and board when the patient receives hospice care at a facility such as an assisted care or skilled nursing facility.
Hospice care only covers the costs associated with the terminal illness. For other medical claims the patient continues to be covered by the regular Medicare plan he or she has, original Medicare or a Senior Advantage Plan.
For those claims not related to the terminal illness the patient is responsible for the normal deductibles, co-insurance or co-payments.
Hospice care is approved in periods of care.
A hospice patient can receive hospice care for two 90-day periods that can be followed by an unlimited number of 60-day periods.
At the start of each period of care the patient must be re-certified that he or she remains terminally ill. A period of care starts the day hospice service begins and continues until the 90 or 60-day period elapses.
A patient can continue to receive hospice care as long as his or her doctor certifies that he or she remains terminally ill and probably has less than six months to live.
If the patient’s health improves or the illness goes into remission the patient will no longer be eligible for hospice benefits.
At that point, healthcare coverage will be received through regular Medicare benefits. A hospice patient always has the right to refuse hospice care at any time and return to regular healthcare coverage.
Tuesday: Seminar, “Listen How We Hear,” Senior Concerns Day Care Center, 401 Hodencamp Road, Thousand Oaks; 7 to 8:30 p.m. For reservations, call 497-0189.
March 10: Seminar, “Clutter, Clutter Everywhere,” Westlake Village Civic Center, 31200 E. Oak Crest Drive, Westlake Village; 1:30 to 3 p.m. Facilitated by the Senior Advocate. For information, call 495-6250.
— Betty Berry is a senior advocate for Senior Concerns. The advocates are at the Goebel Senior Adult Center, 1385 E. Janss Road, Thousand Oaks, CA 91362; phone 495-6250 or e-mail email@example.com (please include your telephone number). You are invited to submit questions on senior issues.