Money is a strange thing to think about in the middle of this, and families often put off calling because they assume they cannot afford it. It is worth knowing what the benefit actually does before you make that assumption.
What's included
For an eligible patient, the Medicare hospice benefit covers everything related to the terminal illness:
- Every visit — nurse, physician, aide, social worker, chaplain, volunteer
- Medication for symptoms and comfort, delivered to the home
- Equipment: a hospital bed, oxygen, a wheelchair, a walker, a commode
- Supplies, dressings and the ordinary things that run out quickly
- Therapy and dietary counseling where they support comfort
- All four levels of care, including short inpatient stays and respite
- Bereavement support for the family for thirteen months afterward
What isn't
We would rather you hear this from us than discover it later:
- Treatment aimed at curing the terminal illness. Care for unrelated conditions continues under regular Medicare.
- Room and board. If your relative lives in a nursing home or assisted living, that rent continues as before.
- Care arranged outside the hospice team. Call us first and we will arrange it.
- Medicare permits a copayment of up to five dollars per prescription, and around five percent coinsurance for respite. Many plans waive both.
The six months question
Eligibility requires two physicians to certify a prognosis of six months or less if the illness runs its expected course. That is a clinical estimate, not a countdown. Patients who live longer are recertified and stay on the benefit. Nobody is discharged for outliving a prediction.
It can be undone
A patient can leave hospice at any time and for any reason, including to try treatment again, and can be readmitted later. The decision is not a door that locks behind you.
If there is no coverage
Call anyway. Nobody should be working out insurance in the middle of this, and there are usually more options than a family expects. If we are not the right answer, we will tell you who is.