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Medicare Hospice: A Benefit that Enhances Quality of Life

Most families want the best for their frail elderly and chronically ill loved ones. They often seek quality medical and long-term care services to be funded with private pay dollars and/or Medicaid. However, most people are unaware of a government benefit that can cover massage services, therapy, spiritual counseling, dietary guidance, housekeeping and comfort care in addition to nursing care, medical care and drugs at little or no cost to the recipient. Why are people not aware of this program? The problem lies with the name of the program: Medicare Hospice.

Doctors and care facilities do discuss hospice coverage with patients and their families, but most people fail to listen or follow up with counseling about the program because of the fear of death and dying. For patients, hospice is the death sentence after a terminal diagnosis - the point at which recovery is not possible and curative treatment is no longer provided. Families and decision-makers of the ill often feel guilty about the choice to enroll their loved one in the hospice program. They feel that they are letting their loved ones die by giving up on active treatment.

What is Medicare Hospice?

If we open our ears and minds, we will discover that hospice care is so much more than a medicalization of the dying process. Rather, hospice services are designed to promote quality of life throughout the duration of a terminal illness. Hospice services are covered under Medicare Part A and provide significant benefits to recipients, not just care and drugs. The program also offers benefits that help families too, such as respite care and bereavement counseling after the recipient's death.

What are the qualifications to receive hospice care under the Medicare program?

To qualify for hospice services, (1) the patient must be eligible for Medicare Part A, and (2) a Medicare -assigned doctor must certify that the patient has been diagnosed with a terminal illness and has a life expectancy of six months or less. Many elders are surprised to learn that they may qualify with chronic conditions such as Alzheimer's/Dementia, COPD, congestive heart failure, kidney disease or a simply an overall failure to thrive due to advanced age or condition. Once the patient has received a terminal diagnosis, he or she may enroll into the program and secure Medicare approved hospice services.

Hospice patients who outlive their projected life expectancy can continue to receive hospice services throughout the duration of their lifetimes provided that their doctor approves additional periods of coverage. Patients may also leave the program at any time for any reason and reenroll back in traditional curative Medicare services.

What services are provided by the Medicare Hospice program?

· Physician Services

· Nursing Care

· Home Care Services or In-Patient Services

· Temporary In-Patient Hospital Services to Manage Pain or to Provide Respite to Caregivers

· Aid and Homemaker Services

· Prescription Drugs for Pain Management and Symptom Control

· Counseling (nutritional, spiritual, and social services)

· Bereavement/Grief Counseling for the Recipient and Their Family Members

· Physical, Occupational and Speech Therapy, Pursuant to a Care Plan

· Music, Massage and Pet Therapy

In addition, Medicare Hospice enrollees can still receive treatment for illnesses, conditions or injuries unrelated to their terminal condition.

Can Medicare Hospice benefits be combined with private services and other government benefits, such as Medicaid and Veterans' benefits?

Yes, hospice benefits can be paired with other services and benefits. For example, it is quite common for Medicaid to pay for nursing and other long term care benefits while the hospice program provides additional services. In most cases, hospice benefits will supplement and not supplant other long-term care and private pay services.

What are the costs of hospice care?

For most patients who receive Medicare Part A services without paying a monthly premium, the costs of Medicare Hospice services are nominal. There is no deductible. There are small co-pays for drugs ($5) and for in-patient services (5% of the daily Medicare rate). Medicare supplement insurance plans will generally cover these out of pocket costs. Those who receive coverage under Medicare Advantage Plans in lieu of traditional Medicare can receive similar benefits but are required to pay the plan's required monthly premium.

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