The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 18: Legal and Financial IssuesSome individuals who are covered by Medicare buy private insurance, called “Medigap policies,”to cover medical costs not covered by Medicare. Medigap policies vary greatly, but many coverthe costs of Medicare deductibles and/or health services and pharmaceuticals not covered byMedicare.26SeveralpicasStates have a program that will pay for the purchasing of a Medigap policy fora person living with HIV.■ Medicare Hospice BenefitThe Medicare program also offers a hospice benefit for those who have a terminal illnesswith a life expectancy of 6 months or less. The hospice benefit provides a range of valuableservices, all of which concentrate on improving an individual’s quality of life as much aspossible during the end stages of a terminal illness. The Medicare hospice benefit coversfour categories of care: 1) routine home care, 2) continuous home-based nursing care, 3)respite care, and 4) general inpatient palliative care related to terminal illness. The hospicebenefit includes services provided by a broad range of caregivers, including physicians,nurses, therapists, home health aides, clergy, social workers, and counselors. It also coversthe purchase or rental of any durable medical equipment necessary to care for the individualin the home. In addition, the program covers the costs of services not typically covered byMedicare such as outpatient drugs, respite care, custodial care, and continuous nursingcare in the home during medical emergencies. The Medicare hospice benefit generallycovers all these programs and services in full. The amount of care received depends on theneeds of the individual and the resources of the hospice–Medicare sets no maximum orminimum limits on the amount of care provided. There may be small copayments forrespite care or prescription drugs. The Medicare hospice benefit does not cover curativetreatment of terminal conditions for individuals who have elected hospice care. The programdoes, however, pay for curative treatment for unrelated conditions, such as injuries resultingfrom an accident or a fall.In order to qualify for the Medicare hospice benefit, individuals must satisfy three basicprogram requirements. They must 1) have Medicare Part A, 2) be certified by their attendingphysician and the medical director of a Medicare-certified hospice to have an advanced,terminal illness with a life expectancy of 6 months or less if the disease runs its normalcourse, and 3) consent in writing to choosing palliative care rather than curative care.Despite these requirements, it is important to note that patients DO NOT NEED to be in aseverely deteriorated physical condition or in an irreversible medical crisis in order tochoose hospice. Choosing hospice earlier in the process, as long as the above requirementsare met, often results in greater comfort and satisfaction for individuals suffering from achronic, terminal condition. Moreover, a patient’s decision to pursue hospice care ratherthan curative care is not final. Any individual who has chosen hospice may return tocurative treatment under the traditional Medicare program at any time by withdrawingfrom the hospice program.Hospice care is divided into the following benefit periods: two 90-day benefit periods andan unlimited number of 60-day periods. These benefit periods may be used continuouslyor at separate intervals. Regardless of how an individual’s periods of hospice care aretimed, she must be certified as terminally ill with a life expectancy of 6 months or less atthe beginning of each period by the medical director of the hospice. If an individual choosesto withdraw from hospice during a benefit period, then any remaining days in that benefitXVIIIU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 371