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What is Hospice & Palliative Care and Who is Eligible?

Hospice vs Palliative Care

Hospice care essentially means “comfort care” and is intended for patients with a terminal prognosis, typically diagnosed with a life expectancy of six months or less, regardless of age. The goal is to make such a patient, whose condition cannot be cured or improved,  as comfortable as possible  in a warm, supportive environment.  All appropriate medication, medical supplies and equipment are included, as well counseling and spiritual support.

Palliative care may be available to anyone of any age suffering from physical and emotional pain and suffering, including that person’s family, and is not tied to a limited life expectancy. Palliative care focuses on the symptoms that cause physical and emotional pain following diagnosis of an illness, and includes medication to alleviate suffering and enhance the quality of life.

Hospice care may be provided in one’s own home, or in a dedicated hospice facility, or in a long-term care facility. Some counties provide free non-medical hospice care services, typically provided by trained volunteers. Perhaps the largest source of hospice care coverage is provided by the Medicare Hospice Benefit, which is available to individuals over 65 years of age. Since this benefit covers virtually everything relating to hospice care, one does not have to be concerned about out-of-pocket costs.

How does one get the Medicare Hospice Benefit?  The patient must satisfy four key requirements:

  • must be eligible for Medicare Part A
  • must have a terminal illness of six months or less
  • must choose hospice care instead of routine Medicare benefits and sign a form certifying that they are making this choice; and
  • must be in a Medicare-approved hospice program

Medicaid, private insurance or pre-paid health plans typically cover hospice most services. One should check their eligibility requirements and scope of coverage.  To be eligible for such coverage, one must have a prognosis of six months or less.