DH on hospice. Do we need medicare supplemental and part D?

Marie58

I'm doing my research and am including this group, because you are the experts! 

DH has been on hospice for over a year and is in a MC facility. He's late stage 7. Bedbound, hand fed, losing weight, sleeping more, has everything done for him. He has medicare A and B, supplemental plan F and part D for Rx. He also has a DNR and comfort measures only POLST.

We have stopped all meds that aren't related to dementia and/or comfort. All the meds he gets now are covered by hospice. Should I get rid of part D?

What about the supplemental? I can't imagine he would get any services that we'd need it for. He has a DNR and comfort measures only POLST. He's bedbound so he's not a fall risk. If he got cancer or something else, we'd never know as we wouldn't test for it or treat it, unless it was for comfort and I believe that would be covered under hospice.

I'm even wondering about part B. He's not going to doctors. The only thing I'm wondering about part B is I believe that part covers covid testing by the MC facility.

I feel like we're paying for something we're not using. Anyone have experience with this or just some thoughts?

Thanks!

Cherjer

What a timely post. My husband was diagnosed in 2015 and has really progressed but not in MC. Today a friend suggested that I look into hospice for him...he can walk but think he may be at end of stage 6. I was looking at our insurance and also have Plan F but wondering if I should drop this for DH. We also have a concierge dr. which costs almost $2000 a year...all this expensive and then the possibility of going into MC at over 8000-9000 (in southern CA) makes me really concerned. We do have caregivers for him...which is better than the expense of MC. He sleeps at night so right now that is not a concern of mine.

I hope you get some good advise from those on this sight and will be looking to see what others have to say. So sorry your husband is so young and dealing with this. My husband was 71 when diagnosed but may have been much earlier in his mid 60s when I think about it.

Ed1937

There is conflicting information online about vaccine coverage, so I called Walgreens. Anyone who wants Covid vaccine is covered by the federal government. But I saw where the funding might run out as early as January, and Walgreens did not have information on that. So at least for the present time, the vaccine is covered for everybody. It seems as though dropping parts B & F would be fine since hospice is involved, but I'll let someone else who might have better information answer that question.

JJ401

I’d ask this question of the hospice you are using. Yes, hospice covers the meds, but are they covering the whole thing or are they billing the insurance and covering the rest?

Marie58

Ed, just to clarify, DH is in MC and they test for covid if there are positive cases in the facility. It's been several months since that has happened, but it looks like part B covers that for now. Regarding the vaccine, DH won't be getting any vaccines whether it's for covid, the flu, etc. So I'm not concerned about coverage for any vaccine. Thanks for checking with Walgreens though.

JJ, hospice covers all his meds as long as they prescribe them for dementia or comfort. We've stopped everything else like blood pressure meds and the like. Hospice didn't cover those as they're not related to his condition that qualifies him for hospice. We used part D for things like that. 

toolbeltexpert

I just want to pass on something I learned from my elder care lawyer. You can suspend the plan f for 20 months , I belive is what she told me. If you cancel it you can't  get plan f back. It isn't offered any more. 

For me that sounds rather risky, I would seek out an elder care lawyer for some advice. I would also look at the statements from medicare and the supplement to see if they are paying anything that may not be picked up. 

Sorry about your dh.

Stewart

Marie58

Thanks, Stewart.

Jo C.

Hello Marie, I can well understand your position wondering whether or not to let go of the supplemental plan and prescription plan due to your husband's being a Hospice patient. 
 

None of us here are experts on such matters and each circumstance will be different from another and we all used different Hospices, so our input will not be what is best for everyone's circumstances and cancelling such coverage can be in some instances be a financial relief or can become a significant problem if unforeseen issues come to pass.

Best to do as suggested and do some research with the professionals. Perhaps a CELA for information, also speaking to the Hospice Social Worker and RN, and even using the federally sponsored SHIP (State Health Insurance Program) entity in your state which is a federally funded and mandated program for no fee Medicare Health Insurance Information with personal one on one Counseling for such matters.  In California, the SHIP is called, HICAP.  The California HICAP number is: (800) 434-0222. (One can also contact their supplemental plan insurance to ask questions there.  Also lots of information online.)  HICAP will provide assistance telephonically. Sometimes it takes a day to get a call returned as the counselors are busy.

I have no personal experience with this dynamic, but have looked at your question as to how I would feel about this if it were happening in our family. I am dedicated to quality of care and protection for my LOs and being able to ensure that needs are covered as best as can be.

It would save a lot of money if one did not have to pay for a Supplemental Plan. However, IF Hospice decided to drop the patient as he/she was not declining sufficiently and has stabilized wherever they are in their decline, then one would be bare without necessary and adequate financial coverage and that could be a significant problem. That's a big one for me as it certainly does happen as many of our Members on this site have shared.

Also; there is no way to tell what meds would become necessary for said comfort that are not covered by Hospice, and as we all know; meds are over the top expensive.

If I wanted to have our own physician follow all the time or even for a single particular matter, (we too have Concierge MDs), or manage something that came up, or if I were not trusting a decision or more from the Hospice MD who does not see the patient, then I would want that choice option which Hospice permits.  Concierge MDs usually will follow the patient in the hospital IF something untoward occurred requiring hospital level of care rather than relegating care over to a Hospitalist which is a huge issue for me. Sometimes, in dire situtations, an acute hospitalization is medically necessary when in Hospice.  Hospice is supposed to cover that for a short stay, but each Hospice is different from another and some are more beneficent, than others.  (One can choose to go on and off Hospice and back on again when one wishes.)

Though unlikely at the point your husband is at for those things mentioned above, I do not know him and of course none of us have a crystal ball; unforeseen things can happen and being risk averse, I am not one to want to leave such matters of that sort to chance . . . but that is just me; others will have a far different take on such matters.

So; for me, I would in all probability continue the coverages - kind of like covering all the bases.  Odds are nothing will happen BUT in any situation, things can happen and in some instances as mentioned, I am that risk averse person. Some of this is based on my personal and professional life experience as an RN whose career spanned years as Administrator of Patient Care Management in acute med centers and have seen it all as well as having a mother, step-dad, MIL and GMIL with different dementias and more. 

Also, some of us are able to budget to keep supplemental plans but not everyone can easily afford such a hit on their budget; not having to pay for a Supplemental Plan would be a huge savings unless Hospice dropped their LO off service or other unforeseen incident occurred.

No easy answers.  You will find your comfort zone that fits your personal situation best.  Keep doing your research and let us know what you decide. 

J.

Marie58

Thanks Jo,

You always have such good advice and experiences to share. You pretty much mentioned everything I've been thinking. 

I've talked with the hospice SW who said others have done this in the past and it was fine. She feels it's highly unlikely DH would ever be released from hospice. I have a call in to SHIP, waiting for the call back. I also have an insurance agent that I discussed part D with. He thinks we're good to drop that. I had the idea to drop the supplemental after I spoke with him, so I'm planning on calling him again. I'm also going to talk to someone at the MC about the covid testing.

I do think the scenarios you alluded to are unlikely, but one never knows, hence the hard decisions to make. I'm somewhat risk averse too, but I'm also looking at my budget. 

Like I said, this group is full of experts who are in the trenches, so I always appreciate input from the members.

Mint

Glad Jo mentioned what she did.  I know a person who hospice dropped even though they had to pick her back up in a short period of time.  Tread carefully

Jo C.

It would be easy to save moneiy by disenrolling your husband from the Concierge MD practice which at this point is no longer providing him any service.  If it is $2,000 per person annual fee,; that is a nice savings; even if it is $1,000 per person, that is still a nice savings for a year.  If cancelled now, the Concierge MD will refund the unused portion of your husband's annual fee that will be unused.  If anything should drastically change, and you want to, you could once again put him back into the Concierge practice.

I would be very questioning and cautious about being told your husband will not ever be dropped from the Hospice; just ask them point blank at WHAT points and under what circumstances would they no longer keep your husband on service and ask them to be bluntly honest. NOTE:  This would be best done by speaking to the Hospice DON at their office who would be that Hospice's authority.  Perhaps that would help with your decision making process.  It is true; things can happen that we do not expect, so getting more knowledge from the Hospice and being in-depth thoughtful regardng your circumstances about doing this can assist in ensuring what may be best for your circumstances.

Best of luck and best wishes being sent your way,

J.

(self edited)

BethL

Marie, what if he falls and breaks a hip? You would need the supplement for hospitalization. What if he gets an infectious disease that requires isolation, and hospice/nsg facility insist they cannot care for him and ship him to a hospital? Being risk averse, I would not cancel the supplement. I also wouldn't cancel part D - ours is less than $11/month. However, the concierge physician would seem unnecessary at this point in his life.

Jo C.

Hello Marie; I am thinking of you and hoping that you are doing okay with the problem solving regarding this decision and more. (I also did an edit of my Post.)  So hope your day is going well; let us know how you are doing, we care.

J.

Marie58

Thanks, Jo. I'm taking my time making a decision. Still have research to do. But I like your idea of talking to the hospice DON. I think she will be honest with me.

We don't have a Concierge MD service.

I'm still hoping there's someone out there who has done this, or considered it, and what they think.

Thanks everyone.

PastorB

Hello, everyone. I had to navigate these waters with my parents, both of whom were under hospice care. My father was in it for over two years. Medicare covers hospice, where it does not cover LTC. The point of hospice is end of life care and for my parents, they covered all medications related to the disease and anything needed such as hospital beds, shower seats, therapy, assistance from nursing aides, and that kind of thing. Both of my parents had issues arise unrelated to the main diagnosis while they were under hospice care and I am glad I kept their Medicare and supplemental plans intact. General rules as I understood them:

* Covers all home care or facility respite care related to the terminal diagnosis. No hospitalization. 

* Covers medication and home care equipment, pain medications, etc. 

* Reevaluation after (in my father's case) one year. For him they decided to continue, but we were concerned they were going to drop him. He remained on it until he died.

* My mother (pancreatic cancer) was undergoing light chemotherapy for pain control. Billed to insurance, not hospice.

Hope this helps a bit. If you keep in mind the rule is comfort care and quality of life until death in hospice, the other answers will become clearer. Keep the insurance unless you are sure you would not call an ambulance in a crisis.

Blessings to you. Nothing about this stuff is easy.

saltom

What a timely post for me.  To my surprise DH does qualify for hospice care, and this post has added a lot of questions to the ones I already have for hospice. We have Kaiser which would stop under hospice. The hospice agency is contracted by Kaiser for Kaiser patients.  DH has uncontrolled orthostatic hypotension, A-Fib and congestive  heart failure in addition to dementia (vascular/Alzheimers) which is probably in early moderate stage.   He has been home for nearly a month following a week in the hospital and three weeks in rehab due to the heart and BP issues. He gets two PT visits and one OT visit per week through next week. He has been getting stronger and his appetite improving somewhat. Hospice has been recommended because of all the services it provides free of cost. I would want him to continue his cymbalta and prostate meds. DH is 89 and I'm 86 and while in fairly good health, the physical requirements of caregiving are difficult - as well as the mental/emotional.  DH was in on the decision to request a hospice referral from the doctor but admits things are very confusing for him. He also hallucinates and accuses me of letting our daughter and SIL kidnap our dog - really their dog that came to visit with them. He's rather obsessed with this.

JJAz

When a patient is discharged from Hospice it is a qualifying event for Special Enrollment Period with Medicare, since it is a change in medical coverage.  This will allow you to enroll in a Medicare Advantage plan (Part C) that covers doctors, testing, hospitals and prescriptions. 

 As an alternative, you could use the Special Enrollment Period to enroll in Medicare Part A (hospital) and Part B (doctors and testing) and Part D (prescriptions) and either go without a Supplement Plan or apply for a Supplement Plan and see if you can pass the underwriting requirements.