Medicare Pilot Program Allows for Hospice Coverage While Still Fighting a Disease

Medicare recipients considering accepting Medicare’s hospice benefit will not be forced to make a fateful decision under a pilot program. The program will allow some Medicare beneficiaries to receive hospice care while also receiving curative treatment from their doctors.

Medicare’s hospice benefit covers any care that is reasonable and necessary for easing the course of a terminal illness.  To be eligible for these comprehensive benefits, a beneficiary must be entitled to Medicare Part A and be certified by a physician to have a life expectancy of six months or less if the illness runs its expected course. Current rules require Medicare beneficiaries who want to use the hospice benefit to stop treatment designed to cure their illness and elect to receive only care that will make their last days more comfortable, called “palliative” care. The hospice benefit has long been underused — fewer than half of eligible beneficiaries use the benefit.

Established as part of the Affordable Care Act (aka “Obamacare”), the Medicare Care Choices Model (MCCM) allows eligible Medicare beneficiaries to elect to receive hospice care while concurrently receiving curative treatment. Participation is limited to beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).

Begun in January 2016, the MCCM is being phased in over two years with a total of 141 hospices participating. The program is expected to continue for five years. Over the course of the MCCM, the Centers for Medicare and Medicaid Services will evaluate how well the MCCM increases access to supportive care services provided by hospice and whether it improves quality of life and patient/family satisfaction.