Q. My mother has been referred to hospice care for end-stage COPD (Chronic Obstructive Pulmonary Disease). I understand that prescription medications related to this condition are covered by Medicare hospice benefits. But what about the other medications that she currently takes for conditions including high cholesterol, elevated blood pressure and low thyroid. Will these continue to be covered under her Medicare prescription plan? Allison W., Jacksonville.
A.I receive a lot of questions about hospice, so your question offers me an opportunity to provide a more detailed explanation about how hospice works.
Hospice addresses the physical, emotional, social and spiritual needs of dying patients and their families. A team of interdisciplinary experts work together to provide palliative care, with the goal of making the patient as comfortable and pain-free as possible during their remaining days, in their own home, if possible.
Hospice care is an option to anyone who has been determined by their physician to be terminally ill and who has six months or less to live. Many families mistakenly believe that it is only a resource to be used for the very last days or weeks of the patient’s life. That is unfortunate because they are not taking advantage of the many benefits it offers. If after six months, the patient requires continued hospice care, he or she may be "recertified" depending on the individual circumstances.
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Ronald Fried, executive vice president for Public Affairs, at Vitas Innovative Hospice Care, a Miami-based chain of end-of-life care providers nationwide, explains: “Hospice focuses on managing a patient's symptoms and provides comfort and dignity during their final weeks or months of life."
There are many companies that provide hospice care but Fried advises choosing one that offers all levels of hospice care, gets high marks for preserving family relationships, and is approved by Medicare.
That last point is important because under the Medicare hospice benefit, all expenses associated with hospice care, including a hospital bed if needed, medical equipment and other supplies, are covered. The patient must sign a form that states they are choosing hospice over other forms of Medicare-covered benefits to treat their terminal illness.
However, when it comes to coverage of prescription drug expenses, as explained in Medicare’s latest policy statement (December, 2013) the “Medicare hospice benefit covers only drugs and biologicals used primarily for the relief of pain and symptom control for the terminal illness and related conditions.” It also states that “the Medicare hospice benefit does not pay for services that are curative in nature.”
In your mother’s case, that means only those medications for alleviating COPD-related conditions are covered by hospice. As an example, if a blood clot medication prevents or alleviates symptoms related to her COPD, they would be paid for under the agreement between hospice and Medicare. But her medicine to control her blood pressure and cholesterol levels wouldn’t because they would not be considered “necessary for the palliation and management of the terminal illness and related conditions.”
Nancy Stein, Ph.D., is the founder of SeniorityMatters.com, a local caregiver advisory and referral service for South Florida seniors and their families. You can contact her at nancy@ senioritymatters.com.