Palliative Care and Hospice Care

End-of-Life Care Options Explained

By Gilbert Guide
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What It Is

To palliate means to ease discomfort by treating symptoms of an illness. Palliative care promotes the patient's comfort by addressing any and all issues causing physical or emotional pain or suffering. Also known as end-of-life care, hospice is palliative care designed to help the patient through the last stages of a terminal illness. The goal is to keep pain and suffering to a minimum, not to cure the illness-by this point, the patient's doctor has determined that the patient can no longer benefit from regular medical treatment. Although hospice care is usually administered in the patient's residence, it can also take place in a hospice facility. When necessary, hospice services can be called into assisted living facilities and skilled nursing facilities, as long as those facilities carry a hospice waiver.

What to Expect

Hospice agencies provide many services, some of which include: nursing, physical and occupational therapy; speech language therapy; medical social services; home health aides; medical supplies and appliances; drugs for symptom control and pain relief; physician services; psychological, spiritual, and nutritional counseling; group and bereavement counseling; caregiver support groups; and grief support.

Paying for Palliative and Hospice Care

Medicare is the principle provider of hospice care in the U.S., but Medicare Part A only pays for hospice care provided by a Medicare-certified program. Medigap does not cover hospice care. Medicaid, Long-term care insurance policies (LTCI) and Veterans Benefits pay for palliative-hospice care. Learn more about the cost of hospice care and how to pay for it.

Medicare

What It Covers

There is usually a 210-day cap on Medicare-covered hospice care. The 210 days are split into two ninety-day periods, followed by a thirty-day period. Each period may be extended when a doctor re-certifies that the patient's condition remains terminal. In some circumstances, coverage may be extended indefinitely.

Medicare pays for most hospice services, including:

  • Nursing services
  • Durable medical equipment such as wheelchairs and walkers
  • Medical supplies
  • Prescribed drugs
  • Short-term hospital care, including respite care
  • Home health aide and housekeeping services
  • Physical, occupational and speech therapies
  • Social worker services
  • Nutritional counseling
  • Grief counseling for patient and family

Conditions and Limitations

Doctor and hospice medical director must verify that the patient has a terminal illness and probably has less than six months to live. Patient must sign a statement choosing hospice care instead of standard Medicare-covered benefits (Medicare will continue to cover health problems unrelated to terminal illness.)

Important Note: Hospice agencies sometimes charge more than Medicare pays. In these instances, the patient is responsible for the balance. Before providing care, the hospice must advise the patient how much of the bill Medicare will pay and inform the patient, in writing, of any items or services not covered. The bill is sent directly to Medicare.

The patient may be charged for:

  • Treatments designed to cure a terminal illness
  • Treatments or services not related to comfort care
  • Room and board (except respite care)

Managed Care

What It Covers

Managed Care policies cover everything that Medicare covers (see Medicare section above).

Conditions and Limitations

Most policies only cover hospice care and services provided by Medicare-certified hospice agencies that are designated by the individual insurance company.

Medicaid

What It Covers

  • RN visits for pain management and symptom control
  • 24-hour, on-call RN
  • Medical social work visits
  • Certified home health aide visits
  • Chaplain visits
  • Trained volunteer visits for support, companionship and errands
  • Bereavement support for 13 months following the death of a loved one
  • Authorized medications
  • Durable medical supplies and equipment
  • Coordination of hospital or skilled nursing facility admissions
  • Respite care (limited to a 5-day stay)
  • Hospital inpatient admission for symptom control

Conditions and Limitations

Before Medicaid will approve coverage for hospice care, you must:

  • Receive a doctor's certification that the individual has a terminal illness and probably has less than 6 months to live
  • Sign a statement choosing hospice care instead of standard Medicare-covered benefits (Medicare will continue to cover health problems unrelated to terminal illness)

Note: Medicaid only pays for hospice care provided by a Medicare-certified agency.

LTCI

What It Covers

Homecare Only and Comprehensive policies usually cover costs of hospice care, while Facility Only policies generally do not.

Conditions and Limitations

Policies vary. Because of potential limitations on hospice care coverage, it is important to carefully compare policies when selecting long-term care insurance. For information on how to determine what kind of LTCI policy suits your needs, visit our blog.

Veterans Benefits

What It Covers

Veterans Benefits cover hospice care.

Conditions and Limitations

  • Veteran must meet eligibility criteria for VA benefits, and
  • Demonstrate need for this type of care