Do Medicare Advantage Plans Cover Hospice Services?
Navigating the world of healthcare coverage for hospice care can be a complex journey, but understanding the options available can empower you to make informed decisions.
This article will explore “do Medicare Advantage Plans cover hospice” care coverage, the process of transitioning between Original Medicare and Medicare Advantage, and additional coverage options such as private insurance, Medicaid, and VA benefits.
By the end of this article, you will have a comprehensive understanding of the hospice care landscape and the various coverage options at your disposal, including the answer to “do Medicare Advantage Plans cover hospice” care.
Key Takeaways
- Understand the basics of hospice care and Medicare Advantage Plans to make informed decisions.
- Medicare Advantage Plans offer coverage for hospice services, but there may be associated out-of-pocket costs and limitations.
- Seniors have the ability to control their end-of life care by stopping and resuming hospice care as needed with support from healthcare professionals.
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Understanding Hospice Care and Medicare Advantage Plans
Hospice care is a specialized form of care focused on enhancing the quality of life for individuals with advanced, life-limiting illnesses.
Medicare Advantage Plans, an alternative to Original Medicare, offer coverage for hospice care.
Grasping the fundamentals of hospice care and the workings of Medicare Advantage Plans aids in sound decision-making.
Hospice Care Basics
Hospice care is centered on providing comfort and support to terminally ill patients and their families, addressing their physical, emotional, social, and spiritual needs.
A hospice team of healthcare professionals, including:
- nurses
- doctors
- social workers
- spiritual advisors
Hospice care can be received in various settings, such as at home, in an inpatient hospice center, or at a nursing home or other facility. The services provided in hospice care plans depend on the patient’s terminal illness and related conditions.
In some cases, care may be provided at a hospice inpatient facility if the patient’s symptoms cannot be managed at home.
Medicare Advantage Plan Overview
Medicare Advantage Plans, also known as Medicare Part C, are health insurance plans provided by private companies approved by Medicare. These plans offer all the benefits of Original Medicare (Part A and Part B) and may include additional benefits such as prescription drug coverage, dental, vision, and hearing services.
Bear in mind that Medicare Advantage Plans can have different costs and rules compared to Original Medicare, usually necessitating the use of a network of healthcare providers.
The primary distinction between Medicare Advantage Plans and Original Medicare is the additional care offered by some Medicare Advantage Plans. These extra benefits may include:
- Vision
- Hearing
- Dental
- Prescription drug coverage
Medicare Advantage Plans amalgamate the advantages of Medicare Parts A and B into a single plan, providing coverage for a wide range of services, from hospital stays to doctor visits. However, each plan comes with its unique rules and costs, hence, it’s advisable to scrutinize the details prior to choosing a Medicare Advantage Plan.
Hospice Coverage Under Medicare Advantage Plans
Medicare Advantage Plans provide coverage for hospice care, including services related to the terminal illness and associated conditions, as well as respite care for caregivers.
However, there may be out-of-pocket costs and limitations associated with hospice care under Medicare Advantage Plans, as well as other expenses not covered by the plan.
Covered Hospice Services
Medicare Advantage Plans cover a range of hospice services related to terminal illness and related conditions.
Pain management, disease severity reduction, and management of the terminal illness and related conditions are key aspects of the hospice care provided under Medicare Advantage Plans.
Beyond the services related to terminal illness, Medicare Advantage Plans also cover inpatient respite care under their hospice care provisions. Respite care provides temporary relief for family caregivers, allowing them to take a break from in-home care responsibilities.
Patients, and their respective families, are liable for a percentage of the cost of respite care at a Medicare-approved facility.
Out-of-Pocket Costs and Limitations
Out-of-pocket costs for hospice care under Medicare Advantage Plans may include a co-payment for certain medications, as well as respite care. The particular medications covered and their associated co-pay amounts are determined by the drug copayment schedule established by the hospice.
Reviewing your plan’s coverage details and discussing with your hospice provider is recommended for a complete understanding of possible out-of-pocket costs.
Keep in mind that unlike Original Medicare, which provides full coverage for hospice services, Medicare Advantage Plans do not.
Therefore, certain services may not be covered, or coverage may be limited based on the terminal condition or disease, quality of care deficiencies, and deductibles. Consult your Medicare Advantage Plan for specific information regarding hospice care coverage limitations and exclusions.
Transitioning Between Original Medicare and Medicare Advantage for Hospice Care
Transitioning between Original Medicare and Medicare Advantage for hospice care is possible, allowing seniors to choose the best coverage option for their needs.
Knowing the steps to switch to Original Medicare for hospice coverage, as well as maintaining Medicare Advantage benefits during hospice care, can provide flexibility and control over end-of-life care decisions.
Switching to Original Medicare for Hospice Coverage
In order to switch to Original Medicare for hospice coverage, you must opt out of your Medicare Advantage plan. Original Medicare covers the costs of medicare certified hospice care, including medical, social, emotional, and spiritual support for those who are terminally ill and their caregivers in the final days or months of life.
Eligibility for hospice care coverage under Original Medicare requires having Medicare Part A (Hospital Insurance), being certified as terminally ill by your doctor, and choosing a hospice provider approved by Medicare.
Once you have switched to Original Medicare for hospice coverage, you will be responsible for the premiums for Medicare Part A and Part B. While Part A covers hospice benefits, Part B continues to cover medical services related to your terminal illness.
Reviewing your plan’s coverage details and discussing with your hospice provider is recommended for a complete understanding of possible out-of-pocket costs and the services covered under Original Medicare.
Maintaining Medicare Advantage Benefits During Hospice Care
Even after the commencement of hospice care, you have the option to stay enrolled in your Medicare Advantage plan. By doing so, you can continue receiving coverage for unrelated health conditions from either Original Medicare or your Medicare Advantage plan.
However, it is important to understand the limitations of maintaining Medicare Advantage benefits during hospice care.
To preserve your Medicare Advantage benefits during hospice care, you must notify your plan, continue paying your premiums, and obtain hospice care through Original Medicare. Collaborate with your hospice provider and comprehend the limitations, such as the fact that Medicare Advantage plans do not cover hospice care during the initial two years.
By understanding these limitations and maintaining open communication with your hospice provider and Medicare Advantage plan, you can make informed decisions about your hospice care coverage.
Additional Hospice Care Coverage Options
Beyond Medicare Advantage Plans and Original Medicare, other options for hospice care coverage, like private insurance, Medicaid, and VA benefits, are available.
Each of these options offers various levels of support and coverage for eligible individuals, providing alternatives for those seeking hospice care.
Private Insurance and Hospice Care
Private insurance plans may cover hospice and palliative care costs, depending on the specific policy. Most private insurance plans generally provide coverage for hospice care, although the extent of coverage may vary.
Reviewing the specifics of your private insurance plan is advised to understand the variations in hospice care coverage, including the services covered, length of coverage, and any potential extra benefits or limitations.
To ascertain if your private insurance plan covers hospice care, you can examine your insurance policy documents, contact your insurance provider directly, or visit the provider’s website. Private insurance may be a viable option for those seeking hospice care coverage, offering additional support and resources to those in need.
Medicaid and Hospice Care
Medicaid hospice benefits vary by state but generally have similar eligibility requirements and services as Medicare. In some states, a co-payment for certain services may be required, depending on income.
It is recommended that Medicaid recipients contact their State Medicaid agency to inquire about hospice benefits available in their region. Furthermore, Medicaid may not cover room and board fees for patients residing in nursing homes or other facilities.
While the specific coverage options and limitations of Medicaid hospice care may vary by state, it can provide a valuable safety net for those in need. Eligible individuals can access hospice care services through Medicaid, providing comfort and support during a difficult time.
Researching your state’s specific Medicaid policies and eligibility criteria is recommended to fully grasp your options for hospice care coverage.
VA Benefits for Hospice Care
Veterans Affairs (VA) may offer hospice care benefits to eligible veterans, providing comprehensive end-of-life care and support. VA benefits provide standard medical coverage, clinical care, and home hospice care as hospice services.
To be eligible for VA hospice care benefits, a veteran must be enrolled in VA health care and have a life-limiting illness with a prognosis of six months or less. Additionally, the veteran must consent to receive only palliative care, which focuses on alleviating symptoms and enhancing quality of life.
To apply for hospice care under VA benefits, veterans should contact their local VA medical center or VA community care provider. They must meet certain eligibility criteria and provide necessary documentation.
VA benefits for hospice care can provide valuable support to veterans in need, ensuring they receive the care and comfort they deserve at the end of their lives, including grief counseling.
Benefit Periods and Stopping Hospice Care
Benefit periods and stopping hospice care allow flexibility for seniors receiving hospice services, with the option to stop and resume care as needed.
Understanding hospice care benefit periods and the process of stopping and resuming care can provide seniors with control over their end-of-life care decisions and ensure they receive the support they need.
Hospice Care Benefit Periods
Hospice care benefit periods consist of two 90-day phases. After those, the beneficiary is entitled to avail unlimited 60-day periods.
As the hospice benefit starts, regular confirmation of terminal illness is required to continue receiving hospice care benefits. The hospice doctor must certify that an elderly individual is terminally ill at the commencement of each benefit period.
This structure offers flexibility and ensures that hospice care is provided for as long as it is needed.
Understanding the structure of hospice care benefit periods is important for seniors and their families to ensure they receive the appropriate support and care during this challenging time. The benefit periods allow for continuous hospice care, providing comfort and support for the duration of the terminal illness.
Stopping and Resuming Hospice Care
Seniors can choose to stop hospice care and resume it at any time, providing flexibility and control over their end-of-life care decisions.
To discontinue hospice care, the patient or their representative should inform the hospice provider, request the revocation of the hospice benefit, and formulate a plan for ceasing hospice services. However, patients and their families should carefully weigh the implications and discuss their choices with healthcare professionals.
Resuming hospice care after discontinuation does not necessitate a fresh certification of terminal illness. The procedure involves:
- Contacting the hospice provider and expressing the desire to resume services.
- The provider will then assess the patient’s eligibility.
- If it is deemed appropriate, the provider will work expeditiously to resume hospice care.
This flexibility allows seniors to tailor their hospice care experience to their unique needs and preferences through a hospice program.
Summary
In conclusion, understanding hospice care coverage under Medicare Advantage Plans and additional coverage options is essential for making informed decisions about end-of-life care.
By exploring the services covered, costs, transitioning between Original Medicare and Medicare Advantage, and the benefits of private insurance, Medicaid, and VA benefits, seniors and their families can navigate the complex world of hospice care coverage with confidence.
As a result, they can ensure that their loved ones receive the compassionate care and support they need during this challenging time.
Frequently Asked Questions
→ How many days of hospice care does Medicare pay for?
Medicare pays for up to two 90-day benefit periods of hospice care, followed by an unlimited amount of 60-day benefit periods.
→ What is one requirement for individuals to be eligible for the Medicare hospice benefit?
To be eligible for the Medicare hospice benefit, an individual must have Medicare Part A coverage and a terminal illness with a life expectancy of six months or less, and must choose to pursue comfort care instead of curative treatment.
→ What is the difference between palliative care vs hospice care?
Hospice care is given when a patient has exhausted all curative treatment options and the focus shifts to providing comfort, whereas palliative care can be provided along with curative treatments to ensure the patient’s comfort.
→ What services are typically included in hospice care under Medicare Advantage Plans?
Hospice care under Medicare Advantage Plans typically includes physical care, prescription drugs, equipment, and supplies for comfort and support, as well as respite care for caregivers.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.