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How to Navigate Health Programs

Read a transcript of an online chat with Judy Peres, a long-term and palliative care expert

In a live online chat, Judy Peres, a member of the AARP Caregiving Advisory Panel, answered visitor questions about paying for care, collecting Medicare and Medicaid benefits, and more. If you missed the chat, check out the below transcript of the conversation.

See also: Caregiving Resource Center

Comment From Kathy: Hi Judy, my dad has stage 4 pancreatic cancer and was finally hospitalized, released to hospice care, and now we are looking for long-term care because he is not in distress or in extreme pain. I am confused and not sure that my 73-year-old father is getting a fair shake. We were told that he can not stay in hospice care for longer then 21 days because that is the limit Medicare will pay. His long-term policy won't kick in until 90 days has passed. We were told by a social worker that the waiting period is often waived on terminal patients. I don't know what the truth is; does Medicare "kick out" terminal patients from hospice care? Can long-term care insurance companies waive the wait fee? Why would anyone ever get long-term care insurance if it doesn't pay out when needed? Lots of questions ... thanks for your help.

Judy Peres: Thanks for writing, Kathy. I am sorry to hear about your father's illness and challenges with the system. It sounds like some of the information you are being given is not totally accurate.

There is no day limit to Medicare hospice coverage. Currently, for Medicare beneficiaries electing the hospice benefit, palliative care services related to the terminal illness are covered. A primary care physician and the hospice medical director must certify that the patient has an expected prognosis of 6 months or less if the patient's disease trajectory follows its normal course. For subsequent periods the hospice physician recertifies the beneficiary. After having been certified by a hospice physician, the beneficiary may elect the hospice benefit for two 90-day periods and an unlimited number of subsequent 60-day periods.

Before the start of each 60-day period, the beneficiary must have a "face-to-face" encounter with a hospice physician or nurse practitioner to determine continued eligibility. Although hospice patients are frequently discharged earlier, they have a right to appeal. Under Medicare, hospice patients have the right to appeal when their provider decides to discontinue hospice care entirely (42 C.F.R. 1/2405.1200(b)). Since each long-term care insurance company sets its own rules, I would suggest you contact your father's plan while you pursue his hospice appeal rights.

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