Can A Terminally Ill Person Lose Hospice Coverage Under Medicare?
The short answer is yes. Medicare will only cover up to six months of Hospice care for a person whose physician certifies that they are terminally ill.
It is possible that hospice patient’s condition improves, and their doctor no longer believes that they will die within the covered 6-month period. In this case, they may be removed from Hospice care. At this point, all their original Medicare coverage will be restored.
A Veteran with Tricare For Life will not lose this insurance upon entering Hospice care, so no restoration of benefits would be needed.
As an example, let’s say that Mrs. Vasquez, the wife of a deceased Veteran, is diagnosed by her doctor with advanced ovarian cancer that the doctor believes will result in Mrs. Vasquez’s death within a few months. The doctor also believes that nothing can be done medically to change that outcome. In that case the doctor would certify Mrs. Vasquez to be eligible for Hospice care, which would begin immediately.
The six-month Medicare coverage for Hospice is divided into two 90-day periods. After the end of the first 90 days the doctor must re-certify Mrs. Vasquez.
However, even though all chemo and radiation therapies stopped when Mrs. Vasquez entered Hospice, for some reason in the fourth month of her Hospice care the tumor shrinks. Mrs. Vasquez’s pain begins to diminish.
By the fifth month, even though Mrs. Vasquez has not been receiving any treatment for her cancer while in Hospice, her doctor and various other specialists are happy to report that the tumor, while not completely gone, appears to be in almost full remission.
Mrs. Vazquez and her family are overjoyed, as are all the Hospice staff. However, Mrs. Vasquez’s medical condition is no longer terminal. Under Medicare guidelines Hospice care must be withdrawn.
While it is wonderful news that Mrs. Vasquez is no longer considered to have a terminal illness, withdrawal of Hospice care will mean that some changes must be made in how her family takes care of her. While these changes may be disruptive, there is much to be grateful for.
Now, Mrs. Vasquez will automatically return to coverage under the Medicare Parts A, B and D that she previously had. Her Tricare For Life benefits will have remained intact during Hospice care. This means that she will again be paying for Parts B & D.
Also, since Mrs. Vasquez was receiving in-home Hospice care, some of the medical equipment that was covered under Hospice is not covered under regular Medicare. It must be taken away.
The pain-killing drugs that she was receiving for her terminal pain are also no longer covered by Hospice. However, they may still be covered (with her co-pay) under her Medicare Part D as well as under TriCare For Life.
There may be other circumstances that affect the type and amount of care that Mrs. Vasquez could receive in addition to Medicare. For example, she may have a Medicare Advantage plan or Medicare supplemental insurance. Since she is the covered spouse of a Veteran and has "Tricare For Life” benefits, these benefits will also reduce her out-of-pocket costs for ongoing medical care.
If Mrs. Vasquez’s cancer returns, or if she develops another condition that her physician determines is terminal, she will once again become eligible for the full six-months of Hospice benefits.
