Medicare Coverage Can Stop Abruptly (While The Kids Fight in the Hallway)
Medicare coverage for inpatient, end-of-life, Hospice care stops once the patient’s condition stabilizes and can be managed at home. Another way to say this is, when the need for inpatient skilled care is no longer necessary, Medicare coverage for that level of care will stop. This is the case even though the patient is in the process of dying. This situation highlights why it is critical that a medical agent is appointed beforehand; the patient needs an advocate.
The determination that there is no longer the need for inpatient skilled care is made by the Hospice physician in charge of the patient’s care. The challenge is that the physician makes rounds when they can, not necessarily when the medical agent is present. Medicare requires the medical staff to present the patient (or medical agent) with written notice of termination of coverage and the guidelines for filing an appeal. Then the patient or medical agent has to sign the notice of termination. If it is the patient who signs, they may not understand the true ramifications of termination and may not remember to tell family about it.
Problems arise if there is no medical agent appointed, or is not available at the time, when notice of termination is presented. Once the notice is given, then the patient is personally responsible for the daily cost of inpatient care until alternative arrangements are made; the bill can be $1,000 per day. Also, if the children are fighting among themselves, or with the patient, they may not know that Medicare coverage was terminated until days or a week goes by at $1,000 per day. If the patient doesn’t have the money to cover the cost, then the Hospice facility will file a claim against the estate.