Original Fee-For-Service Medicare: How To Maximize Use

Custodial care is when you need assistance in your daily activities, and some medication such as for pain, but that you are no longer trying to cure the underlying condition.

The only custodial care that Medicare covers is the Hospice Benefit. Because there have been problems in the past with people remaining on Hospice Benefits for several years, Medicare screens each proposed Hospice claim carefully. The goal of hospice care is to provide symptom and pain reduction care only while the beneficiary is believed to be in the last six months of life.

For Medicare to pay for hospice care, the care must take place in a Medicare-approved hospice.

Before you enter a hospice program, your doctor will speak with you about end-of-life issues and possibly even recommend some counseling. (If you do not have a Living Will and other Advance Directives in place, see Living Wills and Advance Directives.)

Your doctor must be the one to initiate the request for approval of Hospice Care for you, but you should work with him or her in the process.

In order to get the benefit approved, your doctor and the director of the hospice program must both state that they believe your life expectancy is six months or less. If you happen to see this paperwork, don't let it alarm you. It will not be phrased in a pleasant manner. Their goal is to convince Medicare that you are close enough to the end of life to justify granting you the Hospice benefits.

Approval for hospice care is for 90 day periods. You will be approved for hospice care for an additional 90 days if you need it. If you require further hospice care, your doctor can obtain an unlimited number of 60 day extensions after the first two 90 day periods.

If you remain in a hospice for too long, Medicare will look carefully at further extensions to determine whether you should continue to qualify for hospice care. No one is going to complain if you live past six months. No one is going to ask for the money back.

Keep in mind that you always have the right at any time and for any reason to leave the hospice program and go back to regular medical care. Going back to regular medical care will not affect your right to more hospice benefits in the future.

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