Need some fast answers concerning Palliative, Hospice and Medicare

[spncity]

Greetings


If someone in the hospital needs to be



1. in palliative care (staying in the hospital) or



2. in hospice care in a standalone inpatient hospice setting



does Medicare and a Plan F supplemental cover that? (outpatient is not an option).


Thanks.

[rodi]

Here's what little I know... I am just some random stranger on the internet so take it with a grain of salt.

I believe if palliative care is given in the hospital, it is covered under medicare. If it is done in a licensed skilled nursing facility then it would be covered IF it a direct transfer from a hospital stay that lasted 3 days or more. It would be covered under this scenario for a max of 100 days/year and the percentage of cover is based on how far into the stay it is. If the nursing home stay is started after being at home (vs hospital) it is not covered, typically. The medical part of it (dr's/prescriptions) are covered under medicare - but not the housing/bed part.

AGain - I'm not an expert but that's my understanding.

[Scrapr]

My perspective...may not apply in your case. Both times we used Hospice (FIL, wife) Medicare covers all of hospice. Whether in home or not. But...you have to stop active treatment. It's just "comfort" care. Hospice is fully paid by the Feds. No out of pocket to us at all. You may know this but you have to be "accepted" into hospice. A nurse checks the patient out & has to meet several criteria. Nurse calls the Doctor in charge & they chat. The Dr then approves or not.

IIRC we paid during the short pallative care period. But we were over our max OOP anyway. So it didn't matter

Good luck & God bless

[TrvlBug]

My experience: DF was in palliative care in hospital (2006) and it was covered by Medicare. DMIL in hospice care in skilled nursing facility (2017), covered by Medicare.

[audreyh1]

Quote:

Originally Posted by spncity Greetings If someone in the hospital needs to be 1. in palliative care (staying in the hospital) or 2. in hospice care in a standalone inpatient hospice setting does Medicare and a Plan F supplemental cover that? (outpatient is not an option). Thanks.

Medicare pays for hospice. DF didn’t have to pay a dime - he stayed at his care home. He had some comprehensive supplement as well as traditional Medicare.

[Golden sunsets]

What I think the OP needs to know is that hospice care does not pay the Assisted Living facility costs , just the care of the additional services of the hospice care workers. If in a nursing home under hospice, as another posted above, the nursing home portion of the monthly cost of care is only covered up to 100 days, assuming the patient was transferred from a hospital. I don't believe a hospital would allow a patient to stay in hospital for just palliative care. If the patient is transferred to a hospice facility, then medicare foots the entire bill. In the latter case the hospice facility would have to agree to accept the patient, which would I believe be largely dependent on the short term prognosis of the patient.

My DF was transferred from the hospital to a Hospice Facility at the end of his life. He passed away there after 3 days. No bill. My DM, who resided in a Memory Care Assisted Living facility, was placed on Hospice, in August of 2019. So palliative care only. Hospice workers came in several times a week to monitor her health. She was not considered eligible for a Hospice facility, as death was not imminent. She passed in February of 2020. So ongoing Bill's for her monthly care at the ALF, with no increase or decrease in the monthly costs during her time on hospice. There were no bill's from the hospice agency during that time. She was transferred to the hospital after a bad fall in early February, and succumbed a week later. No hospital bills.

[spncity]

Quote:

Originally Posted by Golden sunsets What I think the OP needs to know is that hospice care does not pay the Assisted Living facility costs , just the care of the additional services of the hospice care workers. If in a nursing home under hospice, as another posted above, the nursing home portion of the monthly cost of care is only covered up to 100 days, assuming the patient was transferred from a hospital. I don't believe a hospital would allow a patient to stay in hospital for just palliative care. If the patient is transferred to a hospice facility, then medicare foots the entire bill. In the latter case the hospice facility would have to agree to accept the patient, which would I believe be largely dependent on the short term prognosis of the patient. My DF was transferred from the hospital to a Hospice Facility at the end of his life. He passed away there after 3 days. No bill. My DM, who resided in a Memory Care Assisted Living facility, was placed on Hospice, in August of 2019. So palliative care only. Hospice workers came in several times a week to monitor her health. She was not considered eligible for a Hospice facility, as death was not imminent. She passed in February of 2020. So ongoing Bill's for her monthly care at the ALF, with no increase or decrease in the monthly costs during her time on hospice. There were no bill's from the hospice agency during that time. She was transferred to the hospital after a bad fall in early February, and succumbed a week later. No hospital bills.

Thank you so much for replied to this thread.


I think this is where I need the clarification. Looking at a free-standing 15-bed hospice facility (no outpatient, no nursing home).

Found this on Medicare.gov (Emphasis mine): Room and board.

---->Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility.

---->If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.

The first ---> part is clear.
The second ---> part is confusing, unless the word inpatient in the second paragraph is referring to a regular hospital or nursing home.

Just curious what the daily room and board charges run...

[Aerides]

Medicare has a whole section on hospice on their site:

https://www.medicare.gov/coverage/hospice-care

It seems the main points are eligibility (ie, confirmed terminal, 6 months, etc.,) and location. There's definitely language separating coverage for care vs. facilities.

I would hope that the hospital or medical facility you're working with has staff that are knowledgeable to provide you with some guidance as they must have to help families navigate this transition with some frequency?

[Golden sunsets]

Quote:

Originally Posted by spncity Thank you so much for replied to this thread. I think this is where I need the clarification. Looking at a free-standing 15-bed hospice facility (no outpatient, no nursing home). Found this on Medicare.gov (Emphasis mine): Room and board. ---->Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. ---->If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay. The first ---> part is clear. The second ---> part is confusing, unless the word inpatient in the second paragraph is referring to a regular hospital or nursing home. Just curious what the daily room and board charges run...

Do you expect this respite stay to be of short duration? In any event, the care team at the hospital can surely give you an indication of what they think is likely, once the person is ready to be discharged. They will then place the patient, with the approval of the family.

I also don't know what the small copay refers to either. Room and board charges for either Skilled Nursing or Assisted Living run the gammit, but are not small. My mother's monthly costs were $7,000 per month for an ALF. Many may be $9,000 to $10,000 per month. I don't know about skilled nursing, but they would be more than ALF and also be in a range.

[audreyh1]

Quote:

Originally Posted by Aerides Medicare has a whole section on hospice on their site: https://www.medicare.gov/coverage/hospice-care It seems the main points are eligibility (ie, confirmed terminal, 6 months, etc.,) and location. There's definitely language separating coverage for care vs. facilities. I would hope that the hospital or medical facility you're working with has staff that are knowledgeable to provide you with some guidance as they must have to help families navigate this transition with some frequency?

Basically a doctor authorizes hospice. In DF’s case being severely underweight was sufficient. He was 89 as well, and no longer able to care for himself.

[NateW]

Quote:

Originally Posted by spncity Greetings If someone in the hospital needs to be 1. in palliative care (staying in the hospital) or 2. in hospice care in a standalone inpatient hospice setting does Medicare and a Plan F supplemental cover that? (outpatient is not an option). Thanks.

I do not think Medicare covers hospice care. My experience is during the last 3 months of my mother's life, she went into the hospital due to a fall. Hospital transferred her to a nursing home and she received rehabilitation care paid for by Medicare (Medicare will cover up to 100 days nursing home care if it is for rehab is my understanding). She was a long-term dialysis patient with multiple medical issues with no hope of getting better and at about 80 days into her nursing home stay, voluntary withdrew from dialysis. A few days later she went into hospice (although remained in the same room and nursing home). Medicare did not cover the 3 days she was alive in hospice.

Clarifying my reply after reading some of the replies. The bill for 3 days was from the nursing home for 3 days room and board while Mother was in hospice. It was not from the hospice agency. We did not get a bill from them. So it looks like the hospice service is covered, but if in a nursing home, room and board is not.

[audreyh1]

Yes, Medicare covers hospice. That doesn’t mean they cover the nursing home. Hospice care is generally the nurses, aides, and supplies, specialized equipment used. The hospice organization bills Medicare directly.

[skipro33]

Quote:

Originally Posted by Golden sunsets What I think the OP needs to know is that hospice care does not pay the Assisted Living facility costs , just the care of the additional services of the hospice care workers. If in a nursing home under hospice, as another posted above, the nursing home portion of the monthly cost of care is only covered up to 100 days, assuming the patient was transferred from a hospital. I don't believe a hospital would allow a patient to stay in hospital for just palliative care. If the patient is transferred to a hospice facility, then medicare foots the entire bill. In the latter case the hospice facility would have to agree to accept the patient, which would I believe be largely dependent on the short term prognosis of the patient. My DF was transferred from the hospital to a Hospice Facility at the end of his life. He passed away there after 3 days. No bill. My DM, who resided in a Memory Care Assisted Living facility, was placed on Hospice, in August of 2019. So palliative care only. Hospice workers came in several times a week to monitor her health. She was not considered eligible for a Hospice facility, as death was not imminent. She passed in February of 2020. So ongoing Bill's for her monthly care at the ALF, with no increase or decrease in the monthly costs during her time on hospice. There were no bill's from the hospice agency during that time. She was transferred to the hospital after a bad fall in early February, and succumbed a week later. No hospital bills.

Thank you!
My father is now under hospice at his Memory Care/Assisted Living facility and has been since late February. Your post both confirms my experience and what I can expect.


I want to add;

We do not get any bills for the hospice care, but I do get an invoice. The hospice bill to Medicare is slightly over $8,000 a month. Our cost portion of the invoice is $0. But still, interesting to know how much the hospice company is billing and receiving from Medicare. It's much more than the living facility charges for his residency. About $3,000 more.

[audreyh1]

I haven’t seen any bills or statements mailed to DF. I get the impression that Hospice bills Medicare a lot just from bits I’ve heard. I guess that’s why so many hospice companies are in business. Still, end of life care is an essential service.

[skipro33]

Quote:

Originally Posted by audreyh1 I haven’t seen any bills or statements mailed to DF. I get the impression that Hospice bills Medicare a lot just from bits I’ve heard. I guess that’s why so many hospice companies are in business. Still, end of life care is an essential service.

Medicare sends the invoice to me directly. Not to DF. I suspect because when I signed him up for hospice, I gave them my address for billing purposes. But I can't say for sure. Prior to hospice though, I never got anything for him from medicare. He's on Kaiser Senior Advantage.

[ExFlyBoy5]

Quote:

Originally Posted by skipro33 Thank you! My father is now under hospice at his Memory Care/Assisted Living facility and has been since late February. Your post both confirms my experience and what I can expect. I want to add; We do not get any bills for the hospice care, but I do get an invoice. The hospice bill to Medicare is slightly over $8,000 a month. Our cost portion of the invoice is $0. But still, interesting to know how much the hospice company is billing and receiving from Medicare. It's much more than the living facility charges for his residency. About $3,000 more.

Hospice billing is a bit odd. From the initial admission through a certain period of time, the rate is X amount of dollars (they are paid a daily rate, nothing extra for meds/supplies/etc.) and then after so long (30 or 60 days, I can't recall) the rate goes down. The logic is that the initial care is more intense and requires more visits to establish care...then as time goes on, the visits/requirements tend to "level out." I became very familiar w/ hospice care and its workings with Medicare with my Mom and my Dad.

[Golden sunsets]

Quote:

Originally Posted by skipro33 Thank you! My father is now under hospice at his Memory Care/Assisted Living facility and has been since late February. Your post both confirms my experience and what I can expect. I want to add; We do not get any bills for the hospice care, but I do get an invoice. The hospice bill to Medicare is slightly over $8,000 a month. Our cost portion of the invoice is $0. But still, interesting to know how much the hospice company is billing and receiving from Medicare. It's much more than the living facility charges for his residency. About $3,000 more.

EOB's have been trickling in over the past several weeks, from Medicare. The costs for hospice, prior to DM's fall, are certainly not minor. EG:For the period from 9/1/19 through 9/30/19 the hospice billed amount was $6,054 and the covered amount was $5,800. The rest was a write off: no charge to her. Add that to the $7,000 ALF cost, which she was responsible for and the total would be $12,000+ a month.

[audreyh1]

Quote:

Originally Posted by skipro33 Medicare sends the invoice to me directly. Not to DF. I suspect because when I signed him up for hospice, I gave them my address for billing purposes. But I can't say for sure. Prior to hospice though, I never got anything for him from medicare. He's on Kaiser Senior Advantage.

I see DF’s Medicare statements as I collect his mail. But I haven’t seen a statement since hospice started. I’ve seen earlier statements from when he saw a doctor.

[CoolChange]

I went through this recently. As others have indicated, Medicare did not cover the cost of the nursing home facility in my case but did cover all costs related to nursing, medicine, equipment, etc.


More importantly, in my opinion, thoroughly vet the hospice provider you are considering with nursing home professionals that you trust. You have choices of providers; and, some are much better than others in terms of quality of care. (I did not realize nor did I do this and am still regretting it.) Financials should be the same regardless of the provider you choose.


My sympathies are with anyone making these decisions.