Life After 50 Expo

Dear Marci,

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Dear Marci,

I have Original Medicare and am currently receiving hospice care, but I also need medication to treat my high blood pressure. Since Part A covers all my hospice needs, does that mean I don’t need my stand-alone Part D plan any more to cover my blood pressure medication?

 – Cecilia (Provo, UT)
 Dear Cecilia,

You should keep your Part D plan. Once you’ve elected hospice, the hospice benefit­­ should cover any prescription drugs needed to control pain and manage the symptoms of your terminal condition. But your stand-alone Part D plan will provide coverage for any prescription drugs you need that are not related to your terminal illness.

If your high blood pressure is not related to your terminal illness, then your Part D plan should cover the drugs you need to treat it. The hospice benefit will not cover medications that are not for pain relief and management of your terminal condition. Likewise, you Part D plan will not pay for any drugs related to pain management.

Note that if you had a Medicare Advantage Plan with prescription drug coverage instead of Original Medicare, your non-hospice drugs would be covered by the Medicare Advantage Plan.

If you choose to end hospice care, you should provide your Part D plan written proof of the change so that it can update your status in its systems. If you do not give your plan this information, you may receive medication denials.

Be aware that Medicare assumes that medications prescribed to treat symptoms of pain, nausea, constipation, and anxiety are related to your terminal condition and should be covered by your hospice provider, not your Part D plan.  However, sometimes you may need these types of medications to treat illnesses unrelated to your terminal condition.

To ensure Part D coverage of anti-nausea, anti-anxiety, laxative, and pain medications, it’s best to ask your hospice provider to send information to your Part D plan before you get the prescription filled to indicate that the medication is unrelated to your terminal condition. After receiving this information, your Part D plan must cover the medication.

If Part D is covering a medication, and it is denied at the pharmacy counter, you will need to contact your Part D plan to request a formal decision, called a coverage determination. Your plan must then contact your hospice provider or doctor for information indicating that the anti-nausea, anti-anxiety, pain, or laxative mediation is unrelated to your terminal condition.

Be sure to confirm with your hospice provider that it has actually been contacted and that it has provided the needed information. Your Part D plan must then provide coverage within three days, or within 24 hours if waiting longer places your health at risk. In the meantime, you can ask your hospice to cover a temporary supply of your medication under the hospice benefit.

– Marci

Dear Marci,

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Dear Marci,

My father is terminally ill, and I have been doing research about possible options for his care. I came across information about hospice care, but I am not sure what it is. Does Medicare cover hospice, and if so, what are the requirements?

– Erik (Allentown, PA)

Dear Erik,

Hospice is a type of health care intended to provide compassionate, comprehensive, quality care for individuals with a terminal illness who are facing the end of life. Hospice care focuses on providing comfort and pain management (palliative care), rather than curative treatments for an illness. It usually involves a team approach to care, with doctors, nurses, social workers, and other professionals coordinating care that focuses on physical, emotional, and spiritual needs.

Original Medicare will cover hospice care if your father meets all of the following criteria:

  • He has Medicare Part A
  • The hospice medical director (and his doctor, if he has one) certifies that your father has a terminal illness (his life expectancy is six months or less)
  • Your father signs a statement electing to have Medicare pay for palliative care such as pain management, rather than care to try to cure his condition
  • His terminal condition is documented in his medical record
  • He receives care from a Medicare-certified hospice agency

An individual does not need to be homebound to qualify for the Medicare hospice benefit. The benefit is a comprehensive set of services delivered by a team of providers. A lot of hospice services are provided in the home, but inpatient care is covered under specific circumstances.

The hospice benefit is always covered under Original Medicare. If your father has a Medicare Advantage Plan and elects hospice, Original Medicare will automatically pay for his hospice care. His Medicare Advantage Planwill continue to pay for care that is unrelated to his terminal condition. For example, if your father breaks his hip while in hospice, his Medicare Advantage Plan would pay for hip-related care.

The Medicare hospice benefit covers many different services, including skilled nursing care, prescription drugs related to pain relief and symptom control, spiritual counseling, and more. Medicare will cover these services if they are listed on a beneficiary’s plan of care.

The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods. Your father must have a face-to-face meeting with a hospice doctor or nurse practitioner if he reaches his third benefit period. The third benefit period begins on day 180 of hospice. After that, your father must have face-to-face meetings with a hospice doctor or nurse practitioner before the start of each subsequent 60-day benefit period. The meeting must take place no earlier than 30 days before the new benefit period to confirm that your father still qualifies for hospice care.

If you think your father is eligible for hospice services, you two should speak with his doctor about this care, and request that his doctor contact a Medicare-certified hospice on his behalf. There may be several Medicare-certified hospice facilities in your area. If the first one that you contact is unable to help, try contacting others.

– Marci

Hospice Care Increasing

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Hospice care, which focuses on caring, not curing, is increasing in popularity for people facing a terminal illness.

About 1.5 million people die in hospice care each year.

The Hospice Foundation of America has defined hospice as a special concept of care that provides comfort and support to patients and their families when a person has a terminal illness or disease that is no longer responding to curative care and who has been given a prognosis of about six months of life.

The goal of hospice is to improve the quality of life by focusing on controlling pain and alleviating discomfort.

A team of skilled professionals and volunteers, often called the interdisciplinary team, works with the patient to address all symptoms of a disease. The care can be provided in homes, hospitals and nursing homes and other places.

For more information, visit the Hospice Foundation of America at hospicefoundation.org.