We recently had an informative webinar on Medicare’s hospice coverage and what it is and is not. Below are a some highlights meant to wet your appetite to learn more. We encourage you to view the recording, slides and materials to learn about this important and underused Medicare benefit, and also, how to spot hospice fraud.
Medicare’s hospice coverage is for those who are diagnosed as terminally ill with six months or less to live. A few facts include:
- Hospice helps people who are terminally ill live comfortably.
- Hospice isn’t only for people with cancer.
- The focus is on comfort (palliative care), not on curing an illness.
- A specially trained team of professionals and caregivers provide care for the “whole person,” including physical, emotional, social, and spiritual needs.
- Services typically include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions.
- Care is generally given in the home.
- Family caregivers can get support.
There’s also no formulary when on hospice. As long as the prescriptions you need are for palliative care (not curative), hospice will cover them. And, a nurse and doctor are available and on call 24/7 when on hospice.
Respite care is available for up to 5 consecutive days as well. This means that if your usual caregiver (like a family member) needs rest, you can get inpatient respite care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home). Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but only on an occasional basis.
As not all hospices are created equal, and hospice fraud remains a top scam in California, it’s important to know what your entitled benefits are, and to ask good questions when finding a hospice agency to use. In our recent webinar, Sheila Clark, President and CEO of the California Hospice and Palliative Care Association, stressed this point and gives a list of sample questions to ask and resources to compare hospices. Here are some of the sample questions to ask:
- From the very first phone call, is staff helpful, concerned? Do they answer your questions?
- If you are uncertain about whether hospice is right for you, do they offer an initial consultation so you have an opportunity to ask questions and determine what you want?
- Are you within their geographic service area?
- How quickly will the hospice services begin?
- What is expected from the family caregiver? Will they help you find additional help if needed?
- What will their responsibilities be? What members of the hospice team will you see and how often?
- Do they have a relationship with your personal physician?
- Ask them to explain their 24/7 availability in a situation when you need immediate help.
- How do they define “palliative” or comfort care? Are certain treatments automatically excluded? If you require expensive therapies or devices to manage pain and other symptoms, will they be available?
- What out-of-pocket expenses should you expect?
- Do they provide services for residents in different settings? A nursing home? An assisted living facility?
For more information, view our recent webinar: Medicare Hospice Benefit. What It Is & What It’s Not. Don’t Fall for the Sales’ Pitch! And the slides. You can find these and our other archived webinar materials on our Education Services page.
The National Hospice and Palliative Care Organization also has a helpful tip sheet: Palliative Care vs. Hospice Care.
And, make sure to see our hospice fraud alert available in English, Spanish, Chinese, Tagalog, Korean, Russian, Armenian and Farsi. If you suspect fraud, report it to our California Senior Medicare Patrol (SMP) at 1-855-613-7080.
