Do Medicare Advantage Plans Cover Hospice: A Comprehensive Examination

Hospice care, a specialized form of care for individuals with terminal illnesses, is an essential service for many seniors. The question often arises: "Do Medicare Advantage Plans cover hospice?" This article aims to answer this question and provide a detailed explanation of the coverage provided under Medicare Advantage Plans for hospice care.

Understanding Hospice Care

Hospice care is a specialized form of care designed to provide comfort, not cure, to patients with a life expectancy of six months or less. It includes medical, physical, social, emotional, and other services to manage the patient's illness and pain. The goal is to ensure that the patient is as comfortable and pain-free as possible, independent for as long as possible, and receives care from family and friends. Hospice care also aims to provide support through the stages of dying and allow the patient to die with dignity.

Hospice Coverage Under Medicare Advantage Plans

Medicare Advantage Plans, also known as Part C, are an alternative to Original Medicare, offering the same Part A (hospital insurance) and Part B (medical insurance) coverage. However, when it comes to hospice care, the coverage is always under Original Medicare, even if you have a Medicare Advantage Plan. This means that after electing hospice, care related to your terminal illness will follow Original Medicare's cost and coverage rules.

While you cannot receive curative care for symptoms related to your terminal illness under hospice, Medicare will cover treatment for unrelated conditions. For example, if you have elected hospice because you have terminal cancer and you fall and break your hip unrelated to the cancer, Medicare would cover the physical therapy you need for the broken hip. If you have a Medicare Advantage Plan and need care unrelated to your terminal condition, you can choose to either see providers in your plan's network or see Original Medicare providers.

Costs Covered by Medicare for Hospice Care

Original Medicare covers all costs related to the terminal illness and related conditions, including doctors' fees, nursing care, wheelchairs, catheters, physical therapy, and grief counseling. There are no deductibles. In some cases, there may be a small co-payment for medication to help manage pain or for inpatient respite care if the family needs a rest.

Medicare also covers inpatient care at a hospital if the hospice provider deems it necessary. The hospital stay must be arranged by the hospice provider, and the cost is reimbursed to the hospice provider. Original Medicare also pays for care for health conditions unrelated to the terminal illness, such as a broken arm. Deductibles and coinsurance amounts still apply.

Choosing Between Original Medicare and Medicare Advantage

Seniors receiving a hospice care benefit can choose to leave their Medicare Advantage plan once hospice care begins, but they must pay Original Medicare (Part A and B) premiums. Those who remain in their Medicare Advantage plan pay premiums to their insurer and receive all additional benefits provided by the plan, such as vision or dental care. Original Medicare still covers hospice care if a senior remains in a Medicare Advantage Plan.

The Duration of Hospice Coverage

Hospice care is for people with a life expectancy of six months or less. However, if you live longer than six months, you can still get paid hospice care if the hospice medical director or other hospice doctor recertifies that you're terminally ill. You have the right to stop hospice care at any time. If you'd like to restart hospice care, you may do so at any time if you're still eligible.

Conclusion

Understanding the coverage of hospice care under Medicare Advantage Plans is crucial for seniors and their families. While the coverage for hospice care is primarily under Original Medicare, having a Medicare Advantage Plan does not exclude you from receiving these benefits. It's essential to understand your options and make informed decisions about your healthcare.