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Expert Says Medicare's Hospice Benefit Is 'Grossly Underutilized'

  • May 30th, 2003

Coping with a terminal illness can be a difficult enough experience without having to worry about pain management, medication costs, and assistance with caregiving. Surprisingly, many people do not realize that there is an all-inclusive hospice care benefit available to Americans through the Medicare program.

At a recent meeting of the National Academy of Elder Law Attorneys, Mary T. Berthelot, a staff attorney with the Center for Medicare Advocacy, explained the hospice benefit, which she said is still "grossly underutilized" despite being established two decades ago. Berthelot noted that in 2000 only 23 percent of Medicare beneficiaries who died were enrolled in a hospice program. Fear of "death talk" among both patients and physicians is a principal reason, she said.

Hospice benefits can be delivered at home or in a hospice facility, and these benefits include many services not generally covered by Medicare. The benefit pays for any care that is reasonable and necessary to provide relief from the effects of a terminal illness. This care includes the services of a nurse, physician, home health aide, or counselor. Interestingly, even physical, occupational or speech therapy can be covered as long as these therapies are aimed at improving the patient''s life and making her more comfortable. Even chemotherapy may be covered if it is for comfort, not cure.

Medication related to the terminal illness is covered at no more than a $5 copay. This alone can save a family a huge amount of money, since pain medication is extremely expensive. Of great interest to caregivers is the availability of respite care under the benefit.

To be eligible for Medicare''s hospice benefit, a beneficiary must be entitled to Medicare Part A and be certified by a physician to have a life expectancy of 6 months or less if the illness runs its expected course. But living longer than six months doesn''t mean the patient loses the benefit. After the initial certification period, each beneficiary receives an unlimited number of additional 60-day periods.

In addition, the patient must sign a statement electing the hospice benefit. By doing so, he is foregoing curative treatment for his illness and electing to receive only "palliative" care. Berthelot acknowledged that this is a big step for a lot of people.

A patient is not locked into the benefit once he elects it, however. It''s possible to revoke the benefit and reelect it later, and to do this as often as needed. She also noted that there is no requirement that the hospice beneficiary be homebound, and she gave the example of a patient taking a pleasure trip to Atlantic City.

Benefit recipients are allowed to keep their regular physician, and Berthelot recommends that patients have an independent physician monitoring their care.

Hospices can deliver care to a patient in a nursing home, but there must be a contract between the nursing home and the hospice program. Berthelot said this is something to look into when selecting a nursing facility.

Medicare is only one way that hospice care can be paid for. For example, Medicare-certified hospices must accept all patients, regardless of their ability to pay.

To find a hospice program in your area, visit the Web site of the National Hospice and Palliative Care Organization at www.nhpco.org

To download Medicare''s booklet on the hospice benefit, go to: http://www.medicare.gov/Publications/Pubs/pdf/02154.pdf

Local Elder Law Attorneys in Ashburn, VA

Margaret O'Reilly

Margaret A. O'Reilly, PC
Herndon, VA

Samantha Fredieu

Hale Ball Carlson Baumgartner Murphy PLC
Fairfax, VA

Susan Pollack

Needham Mitnick & Pollack, PLC
Falls Church, VA


Last Modified: 05/30/2003

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