What part of Medicare covers hospice services for a 73-year-old male with terminal pancreatic cancer, Medicare (Medicare) part A, part B, or part D?

From the Guidelines

Hospice services for a 73-year-old male with terminal pancreatic cancer are covered by Medicare Part A. Medicare provides comprehensive hospice coverage for patients certified by a physician as having a terminal illness with a life expectancy of six months or less, as stated in the study by 1. This coverage includes nursing care, medical equipment, medications related to the terminal illness, short-term inpatient care for symptom management, and counseling services. The patient's hospice benefit is not automatically terminated after six months; rather, the patient can continue receiving hospice care as long as a physician recertifies that the terminal condition persists. Medicare requires recertification after the initial 90-day period, another 90-day period, and then every 60 days thereafter.

The hospice team will manage the patient's pain and symptoms related to pancreatic cancer, which typically includes medications like morphine for pain, anti-nausea medications such as ondansetron, and medications to manage other symptoms, as suggested by the study 2. The patient will have regular visits from hospice nurses, social workers, and other team members to ensure comfort and support for both the patient and family during this difficult time. According to the study by 1, hospice care is a subset of palliative care focused on patients near the end of life, and it is essential to introduce the patient to the full range of services available to assure that close attention will be paid to physical comfort, pain management, psychosocial concerns, and spiritual well-being throughout the trajectory of the illness.

Some key points to consider in the care of this patient include:

• The importance of a full assessment of symptoms, including psychological status, as recommended by the study 2
• The need for social supports to be ascertained during the first visit, as stated in the study by 2
• The role of palliative care in achieving the best quality of life for patients with terminal illnesses, as discussed in the study by 1
• The comprehensive services provided by hospice care, including nursing care, medical equipment, medications, and counseling services, as described in the study by 1 and 3.

From the Research

Hospice Services Coverage

• Hospice services are covered by Medicare Part A [(4, 5)].
• There is no evidence to suggest that hospice services are not covered by Medicare or are covered by Medicare Part B or Part D.
• Hospice services are not terminated after six months, but rather, patients can receive hospice care for as long as they meet the eligibility criteria [(4, 5)].

Eligibility Criteria

• To be eligible for hospice care, patients must have a terminal illness, such as pancreatic cancer, and a limited life expectancy [(4, 5)].
• Patients must also meet specific medical criteria, which are assessed by a healthcare provider [(4, 5)].

Enrollment in Hospice Care

• Studies have shown that a significant proportion of patients with pancreatic cancer enroll in hospice care, with rates ranging from 70.5% to 74.4% [(4, 5)].
• However, late enrollment in hospice care is still a common issue, with some patients enrolling in the last 7 days of life [(4, 5)].

Factors Associated with Hospice Enrollment

• Factors associated with hospice enrollment include age, sex, socioeconomic status, and geographic location 4.
• Patients who are older, female, and have higher socioeconomic status are more likely to enroll in hospice care 4.
• Patients who are younger and male are more likely to receive chemotherapy or have an ICU admission at the end of life 4.