From the Guidelines
Hospice care for a 73-year-old patient with pancreatic cancer is covered by Medicare Part A. According to the American Thoracic Society clinical policy statement 1, Medicare requires that a treating physician and the hospice medical director certify that the patient’s prognosis is terminal, with a life expectancy of less than 6 months. To be eligible for hospice care, the patient must also agree in writing to forgo curative treatments for their terminal illness and choose hospice care instead.
Key Points to Consider
- The patient must have a terminal illness with a prognosis of less than 6 months, as certified by a physician and the hospice medical director 1.
- The patient must choose hospice care instead of curative treatments for their terminal illness, and agree to this in writing 1.
- Medicare Part A covers all hospice services related to the terminal illness, including doctor services, nursing care, medical equipment, supplies, medications for symptom control and pain relief, short-term inpatient care for crisis management, home health aide services, social work services, spiritual care, and grief counseling for the patient and family.
- The patient can continue to use Medicare Part B for health needs unrelated to the terminal condition.
Important Considerations for Hospice Care
- Hospice care can be provided in multiple settings, including at home, in a hospice facility, or in a nursing home, depending on the patient’s and family’s needs and preferences 1.
- Patients in hospice programs can be withdrawn from such programs if their condition unexpectedly improves, and they can continue to receive curative treatments if they choose to do so 1.
From the Research
Hospice Care Coverage for Pancreatic Cancer Patients
- Hospice care for a 73-year-old patient with pancreatic cancer is typically covered by Medicare Part A, as it is considered a benefit for patients who are terminally ill and have a limited life expectancy 2.
- Medicare Part A covers hospice care, including medical and support services, for patients who meet certain eligibility criteria, such as having a terminal illness with a prognosis of six months or less to live 3, 2.
- Medicare Part B may cover some medical services related to pancreatic cancer treatment, but it is not the primary payer for hospice care 4, 5.
- Medicare Part D covers prescription medications, but it is not directly related to hospice care coverage for pancreatic cancer patients 6.
Eligibility and Utilization of Hospice Care
- To be eligible for hospice care under Medicare, patients must have a terminal illness, such as pancreatic cancer, and a prognosis of six months or less to live 2.
- Studies have shown that hospice utilization among pancreatic cancer patients has increased over time, with approximately 56.9% to 74.4% of patients using hospice services at the time of death 3, 2.
- Early hospice enrollment, defined as enrollment at least four weeks before death, has been shown to be associated with lower Medicare expenditures during the last month of life 2.