Sharon S. Richardson Community Hospice - Sheboygan, WI

What You Need to Know About the Medicare Hospice Benefit

Last November, in this column I wrote an article titled “Are Medicare patients unknowingly forfeiting their hospice benefit?”  Based on the phone calls I received I believe I have some explaining to do.  Folks are asking “What am I doing wrong?”, “How can I be sure I get hospice if I need it?”, and “Won’t my doctor handle everything for me?”  

First, let me assure you that I wasn’t implying anyone has done anything wrong.  It’s what we’re not doing that is concerning.  We’re not having important conversations early enough.   If you are a Medicare recipient or if you are caring for someone who has Medicare, you should review the Medicare hospice benefit BEFORE you need hospice care.  Here is a sample of the eligibility requirement (You can find the full Medicare hospice benefit document online at

•    You’re eligible for Medicare Part A (Hospital Insurance)
•    Your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less to live if your illness runs its normal course
•    You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness 

The words “6 months or less to live if your illness runs its normal course” explains how a doctor determines if a patient should qualify for hospice.  This does not mean that a person who elects hospice will most certainly live only six months or less.  Illnesses affect each of us differently.  If after six months a patient is still living but is not improving then they are still eligible for hospice.  Once an individual elects the hospice benefit, he or she can change their mind at any time for any reason.  Hospice is a choice.  

Unfortunately, doctors don’t always present this choice when a patient has reached that “6 months or less to live if the illness runs its normal course” criterion. Because activating the hospice benefit requires certification from a physician and a hospice medical director, people assume that their doctor will order hospice when the time is right.  In reality, it is often up to the patient or the family to ask the right questions and understand all of their options.

Some doctors have confessed that they feel like they are failing if they stop trying to prolong a patients’ life. Sadly, sometimes the life-prolonging treatments greatly diminish the patient’s quality of life.  Hospice professionals believe everyone should be fully informed of their healthcare options and the effect each option will have on their quality of life.  

So what should you do?  Talk with your family and your doctor early about your goals for end-of-life care.  Document your wishes for receiving or limiting life-prolonging interventions such as feeding tubes, ventilators, and aggressive therapies. Understand that hospice is a choice and that you may have to ask for it.  You can even choose your hospice provider as long as they are Medicare certified.  Explore your options early.  Don’t wait for a crisis.