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Ask Sid: Are All Hospice Costs Covered by Medicare?

Q. After my father was ruled eligible for hospice care by his doctor, the hospice agency arranged to have him moved from the hospital to an assisted living facility, which demanded an up-front payment. Isn’t hospice care covered by Medicare?

A. Medicare does not cover room or board, no matter whether the patient receives hospice care at an assisted living facility, nursing home or even a hospice residential facility.

What is covered: medical supplies and care from doctors and hospice nurses, social worker services, home health aides and homemaker services, counseling and some types of therapy. Patients (or their families) are responsible for no more than $5 for each prescription to manage pain and symptoms, while Medicare pays the rest. Medicare may also pay most of the costs for short-term respite care at an approved facility for family caregivers who need a break.

But beware of possible skimping on necessary care.

“Most hospice services do a great job, but because they are reimbursed on a per diem basis, we hear horror stories about some that want to increase revenue by minimizing their expenditures—such as not providing oxygen to patients who need it,” says Ron Panzer of the Hospice Patients Alliance.

While hospitalized, patients who are eligible for hospice care should be informed of all hospice providers in their area, so beware of “sweetheart” deals in which hospital employees recommend only one hospice service.

“The best advice is for a family member to be there with the patient, so they can be informed about what is the proper care for their loved one, and can ensure it is completely being provided,” Panzer says.

Sid Kirchheimer writes about consumer and health issues.

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