Hospice and Medicare

[vic120]

I have a client how her and husb has had Medicare supplement for some time with me

Now her husb is on hospice and I guess someone is giving her advice, and she wants to cancel her husb supplement and Medicare part B
because she has been told all he needs in Medicare part A now and everything will be covered by the part A
Now she is more asking me what I think

I have not really run into this before I feel this is not a good Idea but I really dont know

I found this online
When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for services related to the treatment and management of his or her terminal illness during any period his or her hospice benefit election is in force,

thoughts?

 

[rmhaire]

I have not really run into this before I feel this is not a good Idea but I really dont know

I've run into it before but I wish I hadn't. My wife was on it for 11 years.

Technically, the advice your client was given is correct. So is the article you read. But as usual there's more to the story. Always is.

When a person signs up for hospice they sign a contract that basically forbids them from going to their regular doctor or the hospital. Doing so voids their contract.

There are exceptions to this though. A dentist or say a podiatrist would be an exception.

All hospice claims are paid under part A at 100% including your drugs. That's why your client is getting this advice. But here's why they should consider keeping their supplement at least for now.

Not everyone that goes on hospice stays on hospice. People get kicked off every day. Hospice is one of the few services that you have to prove you're dying. And you have to prove it on a certain schedule.

And not all hospice companies are the same. Part A only pays what the hospice company covers. No bill no payment. And a big difference is their medications. It's up to the individual hospice company to decide what they want to cover.

It may seem like paying that supplement premium is a waste of money but I'd suggest waiting a bit.

Hospice never ends the way you think it will.

 

[DonP]

I've run into it before but I wish I hadn't. My wife was on it for 11 years.

Technically, the advice your client was given is correct. So is the article you read. But as usual there's more to the story. Always is.

When a person signs up for hospice they sign a contract that basically forbids them from going to their regular doctor or the hospital. Doing so voids their contract.

There are exceptions to this though. A dentist or say a podiatrist would be an exception.

All hospice claims are paid under part A at 100% including your drugs. That's why your client is getting this advice. But here's why they should consider keeping their supplement at least for now.

Not everyone that goes on hospice stays on hospice. People get kicked off every day. Hospice is one of the few services that you have to prove you're dying. And you have to prove it on a certain schedule.

And not all hospice companies are the same. Part A only pays what the hospice company covers. No bill no payment. And a big difference is their medications. It's up to the individual hospice company to decide what they want to cover.

It may seem like paying that supplement premium is a waste of money but I'd suggest waiting a bit.

Hospice never ends the way you think it will.

Home hospice has become big now . I've seen people live 18-24 months on that . Would they not go to regular dr either ?

 

[rmhaire]

Home hospice has become big now . I've seen people live 18-24 months on that . Would they not go to regular dr either ?

Nope. Doesn't work like that.

Think of it as checking into the nursing home. Only difference is that it's done at home kinda like HHC.

Once you sign up you'll be treated by the hospice doctor. No others unless approved. And no hospital trips either unless approved.

You may or may not get to keep your pharmacy. Again, up to the hospice company that you decide to go with.

If you're at home, everyone comes to you. Nurses, aides, everything you need.

For patients that are already in a nursing home it's still the same with a few exceptions. Some nursing homes refuse to allow certain hospice companies in their building. When that happens you have to make a change.

 

[DonP]

Nope. Doesn't work like that.

Think of it as checking into the nursing home. Only difference is that it's done at home kinda like HHC.

Once you sign up you'll be treated by the hospice doctor. No others unless approved. And no hospital trips either unless approved.

You may or may not get to keep your pharmacy. Again, up to the hospice company that you decide to go with.

If you're at home, everyone comes to you. Nurses, aides, everything you need.

For patients that are already in a nursing home it's still the same with a few exceptions. Some nursing homes refuse to allow certain hospice companies in their building. When that happens you have to make a change.

My mother had Alzheimer's and when she stopped eating much they recommended hospice . No food .water or anything . It's basically to end it in days . But even in the nursing home there's little going to hospital and such forth unless an emergency

 

[rmhaire]

My mother had Alzheimer's and when she stopped eating much they recommended hospice . No food .water or anything . It's basically to end it in days . But even in the nursing home there's little going to hospital and such forth unless an emergency

Sorry to hear about your mother. Alzheimer's is a terrible disease.

Most people freak out when they think of someone starving. But it's really quite peaceful.

And it's not the eating and drinking part but forgetting how to swallow. Once the patient reaches that stage they don't know they're hungry or thirsty.

 

[vic120]

Lot of good info here thank you guys

 

[annon123]

Some cases of being in hospice are incredibly clear cut as there is a triggering illness that has a pretty well known life span and so the odds of hospice eligibility ending is slim to none. Other cases the person's amount of life left is unknown, other cases they improve - this so depends on what is wrong with them and that they follow the "usual" path.

As others have said the risk is taking someone off of their other stuff is if they actually don't stay in hospice. Then they may or may not fail medical underwriting trying to get back on their supp if that is what they had in addition to B rather than MA, depending on their issues and the company's underwriting rules.

It also depends on why they are on hospice (well other than they are eventually going to die as we all are). Many don't land in hospice until shortly before they die and many could have used it far sooner than they did, although with many issues you can't predict that. Our family/extended family experiences have been all over the map.

Two aunts we knew would die due to stage 4 cancer (same kind of cancer) and choosing to finally stop chemo where life expectancy wasn't long due to how aggressive that cancer is not to mention 5 year survival is very poor. Canceling would have made sense once they entered hospice (both were eventually in in home hospice) as they never would have been discharged from hospice as they would have continued to decline.

A cousin had a brain tumor removed, did chemo but wasn't completely in remission, finally was in hospice for 3 or so months and surprised everyone and started to improve, was kicked out, then did more chemo again, and died 3 years later due to a heart attack. So canceling his stuff would have backfired as he would have failed medical underwriting (had a supp).

Another aunt had Parkenson's and was in a nursing home for that for a couple of years and then put into hospice. She was kicked out of hospice as her decline had stabilized shortly after being put in hospice. She lived another year or so (and was put back in hospice again near the actual end of her life). Canceling everything in this case would have been problematic.

Mom had 6.5 years of long term care insurance and she used all but 3 days of that (transferred to hospice then). She started declining far more rapidly this January (due to nothing acute - rather just old age), but since she had long term care through April and the nursing home was good, nothing was done to change anything - not to mention no one had any idea how long she'd live since her decline had been so slow over the years. We applied for hospice 7 days before her long term care insurance ended (we weren't sure how long that took and didn't want a gap, she was accepted in it the last 3 days of April). She died May 6th. Clearly she could have used hospice sooner than she got it but we didn't know that.

In retrospect right before we applied for hospice for her she was showing the early stages of the 2 or so week process of dying. But those symptoms can also be due to other things and we actually took her to the doctor a few days before she was accepted in hospice about them and he didn't realize she was in the early stages of dying either so was treating her for something else (which, who knows, she could have had too). The last 3.5 days of her life it was clear she was dying. No one even thought about canceling everything as we were focused on her dying. What to do in mom's case about the rest of her insurance was ambiguous until the very end of her life. If she ended up living a bunch of months more then her macular degeneration shots mattered (and she got her April one) and so she would have needed her other insurance.

Hard decisions about what to tell her to do. And, I would think, would depend on why her husband is in hospice, the "usual" progression of that disease (if any underlying issue, other than old age, triggered the placement) and whether or not the person is "following" the usual progression - something that may not be known for a while.

 

[annon123]

Sorry to hear about your mother. Alzheimer's is a terrible disease.

Most people freak out when they think of someone starving. But it's really quite peaceful.

And it's not the eating and drinking part but forgetting how to swallow. Once the patient reaches that stage they don't know they're hungry or thirsty.

The forgot how to swallow is what happened with my mom too. Needed to tell her to chew and then to swallow with each bite. Sometimes telling her to swallow more than once. She was switched to a liquid diet which didn't solve the swallowing issue. Mom didn't know she was hungry or thirsty either. She did still like the taste though of some foods in her mouth.

I was told to try to feed her something about 4 days before she died and she asked me, "What's the point (of eating)?". She lost her ability to clearly speak about two days after that (the day before that we'd have to remind her to use her lips and tongue when speaking so we could understand her so I am presuming forgot how to do that as well as no evidence of a stroke). I made the decision, after reading about the dying process, to only ask her if she wanted something she liked the taste of in her mouth, if she shook her head yes to something specific I'd put a small amount on a spoon and then catch it as it dribbled out with a napkin if I couldn't get her to swallow or spit it out. As you said, she didn't seem to be suffering from not eating, rather she was suffering more from us trying to make her eat right before she died.

 

[annon123]

For patients that are already in a nursing home it's still the same with a few exceptions. Some nursing homes refuse to allow certain hospice companies in their building. When that happens you have to make a change.

And we found with mom it was the hospice doctor/NP that decided what meds she got or didn't get, not the nursing home (or other) doctors. Mom was only in hospice about a week and they stopped all her "regular" meds when it was clear she was actively dying the last couple of days of her life.

Also some nursing homes require the hospice people to write an actual prescription for new meds, others take verbal orders. Know in advance what the situation is so the person in hospice doesn't suffer due to failure to follow the "rules".

My mom was in acute pain about 3 days before she died for about 6 hours with us calling all over the place trying to get hold of the "right" hospice person to fax the order so mom could have more than tylenol (which wasn't working) to address her pain. They had already made their daily visit, told us they were ordering a PRN pain med (they did give her a shot while they were there - it was when it wore off there was the problem), and otherwise wouldn't be returning until the next day (time not specified). Cripes that hospice knew that they required a written order and so did the nursing home. One didn't leave the order and the other didn't ask for the order knowing they'd need it. Sheesh. Had we known we would have micromanaged this and maybe pissed them off (too bad) by following the hospice worker to the nurse's station to make sure an order was written.