Do Medicare Advantage Plans Cover Hospice Care?
Understand how Medicare Advantage plans interact with hospice care. Get clear insights into coverage, costs, and what your plan still covers.
Medicare Advantage plans offer a way for individuals to receive their Medicare benefits through a private insurance company. These plans generally provide all the coverage of Original Medicare (Part A and Part B) and often include additional benefits like prescription drug coverage. Hospice care focuses on providing comfort and support for individuals facing a terminal illness, aiming to improve quality of life rather than seeking to cure the underlying condition. This article clarifies how Medicare Advantage plans manage hospice coverage for their enrollees.
What Hospice Care Entails
Hospice care represents a comprehensive approach to comfort and support for individuals with a terminal illness, shifting focus from curative treatments to pain and symptom management. Its goal is to enhance the quality of life for the patient and their family during the final stages of life. Hospice care is typically provided in the patient’s home, but can also be offered in inpatient hospice facilities, hospitals, or nursing homes.
Services commonly covered under hospice care include physician services, nursing care, and medical equipment necessary for comfort. Medications for pain and symptom control are also provided. Hospice care extends to medical social services, spiritual counseling, and dietary counseling. Physical, occupational, and speech-language pathology services may be available for symptom control or to maintain daily living activities. Hospice aide and homemaker services are also part of this care, along with grief counseling for the family, provided both before and after the patient’s passing.
How Medicare Advantage Handles Hospice Coverage
When an individual enrolled in a Medicare Advantage plan elects to receive hospice care, Original Medicare (Part A and Part B) becomes the primary payer for all services related to the terminal illness. This means the Medicare Advantage plan does not directly cover the hospice benefit itself.
The beneficiary must choose a Medicare-approved hospice provider. Upon election of the hospice benefit, Original Medicare assumes responsibility for the costs of hospice services. The Medicare Advantage plan’s role shifts during this period, but it does not completely cease. This arrangement ensures individuals receive the specialized care they need.
Financial Aspects of Hospice Care
The Medicare hospice benefit is designed to minimize out-of-pocket costs for individuals receiving end-of-life care. There is no deductible for hospice services. Patients pay nothing for hospice care if they receive it from a Medicare-approved hospice provider.
However, a few specific costs might be incurred. A small copayment, up to $5, may apply for each outpatient prescription drug for pain and symptom management. If short-term inpatient respite care is utilized, a coinsurance of up to 5% of the Medicare-approved amount may be charged. This respite care allows a caregiver a temporary break, typically for up to five consecutive days. Room and board charges are not covered by the hospice benefit if the patient resides in a nursing home or other facility.
Maintaining Other Medical Coverage
Even after electing the hospice benefit, a Medicare Advantage plan continues to play a role in the enrollee’s healthcare. The Medicare Advantage plan remains responsible for covering medical services and treatments not related to the terminal illness for which hospice care was elected. This ensures continuity of coverage for unrelated health needs.
For instance, if an individual is receiving hospice care for a terminal illness but experiences a fall and breaks a bone, the Medicare Advantage plan would cover the treatment for the broken bone, as it is unrelated to the terminal condition. Routine doctor visits for other pre-existing conditions, medications for illnesses distinct from the terminal diagnosis, or emergency care for non-hospice issues also continue to be covered by the Medicare Advantage plan. Any additional benefits offered by the Medicare Advantage plan, such as vision or dental services, remain active as long as the beneficiary continues to pay their plan premiums.