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MEDICARE AND HOSPICE CARE

FOCUS ON COMFORT

Hospice care is intended to ensure that those who are in the final stages of a terminal illness are cared for and comfortable. It is not to cure a current disease process. Instead it is to help provide a more holistic or all encompassing level of care. The patient’s medical, emotional, mental, social and religious needs are addressed. Prior to entry into a Medicare hospice program you and your family will meet with your hospice team to address the families needs, obviously with primary focus on the patient. Included within that plan, there could be social workers, dietary consultants, nurses, physicians, speech pathologists or any other medical professional that is Medicare eligible.

There are times when a hospice care plan will include bereavement counselors and priests or chaplains. Care can even be provided in home, unless your hospice team determines that the level of needed care can only be provided in an inpatient facility. If the care is in home and one of the primary caretakers needs a break, Medicare authorizes respite care for up to five days each time respite care is authorized. Respite care may be available more than once it is not authorized more than once very often.

HOW TO QUALIFY

To qualify for hospice care the patient must be eligible for Medicare part A (hospital insurance), pick (and ultimately enroll) in a Medicare eligible hospice program and your treating physician must certify that you you likely have less than six months to live if your disease runs its typical course. Finally, you must accept the hospice care and give up treatment for your illness. It is important to note that you can always give up hospice care and go back towards trying to heal your illness. But this decision to give up trying to treat or heal your illness is a major decision and not one that should be taken lightly.

Part of the same decision means that you must give up any medication that you are using to treat your disease and only take medication to control the symptoms or for pain relief. You are NOT required to sign or authorize a do not resuscitate order. It is also important to note that if you have any other conditions independent of your terminal illness they will continue to be treated. While the coverage is only certified for six months, it is not only authorized for six months. Your treating physician can recertify you for hospice care as need be. As long as your treating physician believes you have less than a six month life expectancy you are eligible for recertification. It is common for illness to go into remission or for your overall health to improve, thus negating the need for hospice care.

WHAT IS AND IS NOT COVERED

If the hospice care is provided at an inpatient facility, you will pay five percent of the Medicare approved daily rate. Any prescription medication that is necessary for palliative care or for treatment of an injury or illness independent of your terminal illness. It does not cover room and board if you reside at home or a residence outside of an inpatient facility. It does not cover emergency room treatment for matters related or secondary to your terminal illness although you may be treated for conditions independent to your terminal illness at an emergency room.  

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