From Medicare Rights Center. Main takeaway, especially for Verizon retirees: hospice care is under Medicare not under Medicare Advantage. Medicare Rights Center is a non-profit, non-governmental source of information, advice, and advocacy for those of us with Medicare. Click on links in article for more information.
Go here for other Medicare Rights information: https://www.medicarerights.org/
Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit is primarily home-based and covers end-of-life palliative treatment, including support for one’s physical, emotional, and other needs. It is important to remember that the goal of hospice is to help an individual be as comfortable as possible, not to cure an illness.
To elect hospice, someone must:
Be enrolled in Medicare Part A
Have a hospice doctor certify that they have a terminal illness, meaning a life expectancy of six months or less if the illness takes its normal course
Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care
And, receive care from a Medicare-certified hospice agency
Once an individual chooses hospice, all of their hospice-related services are covered under Original Medicare, even if they are enrolled in a Medicare Advantage Plan, unless their Medicare Advantage plan is part of a specific demonstration program, in which case the plan will pay for hospice care. Their Medicare Advantage Plan will continue to pay for any care that is unrelated to their terminal condition. Original Medicare payments to the hospice provider also cover any prescription drugs needed for pain and symptom management related to the terminal condition. The individual’s stand-alone Part D plan or Medicare Advantage drug coverage may cover medications that are unrelated to their terminal condition.
The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods The doctor must recertify the person’s terminal illness before each benefit period.
If someone you care for is interested in Medicare’s hospice benefit:
Ask their doctor whether they meet the eligibility criteria for Medicare-covered hospice care.
Ask their doctor to contact a Medicare-certified hospice on their behalf.
Be persistent. There may be several Medicare-certified hospice agencies in your area. If the first one you or the doctor contact is unable to help, contact another.
Once you have found a Medicare-certified hospice:
The hospice medical director (and the individual’s regular doctor if they have one) will certify that they are eligible for hospice care. Afterwards, the individual must sign a statement electing hospice care and waiving curative treatments for their terminal illness.
Their hospice team must consult with the individual (and their primary care provider, if they wish) to develop a plan of care. Their team may include a hospice doctor, a registered nurse, a social worker, and a counselor.
Hospice fraud occurs when Medicare is falsely billed for any level of hospice care or service. As the family member of a Medicare beneficiary, you should look out for suspicious behavior from health care providers that might indicate Medicare fraud or abuse.
Report potential hospice fraud, errors, or abuse if you or a loved one are:
Being abused or neglected by a hospice worker
Receiving inadequate or incomplete services
Not receiving the services and care outlined in your doctor’s plan of care
Falsely certified as being terminally ill in order to qualify for the hospice benefit
Enrolled in hospice without your or your family’s permission
Offered gifts or incentives to receive hospice services or to refer others for hospice services
Have your medication stolen by a hospice worker
Billed for a higher level of care than was needed or provided, or for services not received (you can find this information on your Medicare Summary Notice or Explanation of Benefits)
Experiencing high-pressure and unsolicited marketing tactics of hospice services
Kept on hospice care for long periods of time without medical justification
To report potential hospice care fraud, errors, or abuse, you should contact your local Senior Medicare Patrol (SMP). Your SMP can also help you identify possible concerns. Find your local SMP by visiting www.smpresource.org or calling 877-808-2468.
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