Toni Says: Understanding Hospice

Published 8:32 am Monday, May 17, 2021

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Hello Toni:

As a certified case manager and critical care unit RN, I am advising adult children who are desperately seeking advice for their parents that are closing in on end-of-life issues.  Those that have serious health care issues should be offered every option for proper planning as end-of-life care…most appropriately… hospice!

Can you explain hospice for your readers as I am sure this will help those who are seeking answers for their frail loved ones and give the caregiver some well needed rest?

Thanks in Advance…Susan from Denver area


HOSPICE…is a subject no one wants to discuss to their elderly family member when they are ill but can seriously help a family when their loved one is terminally ill as the illness takes a toll on the caregiver and the patient.

Many people wait too long to begin hospice benefits and believe hospice is for the last days to help a person die peacefully. Many doctors and individuals wait too long to order and receive hospice.

Hospice can give hope along this journey with education, medication to manage symptoms, support to the patient and family, and counseling services for the patient, family members and care givers.

Health care professionals in the hospice system consist of physicians, nurses, social workers, spiritual counselors, certified nursing assistants and volunteers. A hospice provider comes to where the patient lives to provide the care.

In the Medicare & You handbook, it explains what hospice is in Medicare terms and what Medicare covers for hospice under Part A of Medicare.  A doctor that orders hospice must certify that you are terminally ill and have 6 (six) months or less to live.  When you agree to hospice care, you are agreeing to comfort care (palliative care) instead of care to cure your illness. You also must sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness.

Hospice can be recertified every 6 months by a hospice medical director or hospice doctor if you are still terminally ill.  Original Medicare will be billed for your hospice care.

Hospice will cover all medical care for the terminal illness and Medicare will pay for health problems that are not related to your terminal illness (co pays will apply). Medicare-certified hospice care is usually given in your home or other facility where you live, like a nursing home.

For those who are enrolled in a Medicare Advantage plan, when you are receiving hospice, the hospice benefit will be paid for by Original Medicare, not your Medicare Advantage plan. You will pay your co pay for any medical care that is not associated with the terminal illness.

Medicare costs under Hospice:

  • You pay nothing for hospice care (Medicare pays)
  • You pay a copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
  • You pay 5% of the Medicare-approved amount for inpatient respite care.

You can choose to walk through this journey helpless or have control over your end-of-life plan of care.  Know that hospice provides comfort, dignity, protection of your wishes, love, and support.

Talk with a geriatric case manager or geriatric doctor if you have some concerns or need some advice with your loved one’s terminal healthcare issue.

For assistance with enrolling and personalizing your Medicare contact the Toni Says® office at 832/519-8664.

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Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the new 2021Medicare Survival Guide® Advanced book at Have a Medicare question? Call 832/519-8664 or email