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Medicare Advantage, Palliative Care and Hospice: What You Need to Know
CMS (the Centers for Medicare and Medicaid Services) has been working on what they call, “Value-Based Insurance Design” or VBID. Within this working model, what we anticipate will happen is the Medicare Advantage hospice carve in. In other words, hospice will become part of Medicare Advantage. How that will work and how it will affect your care when that stage arrives, is still yet to be determined.
This is something we need to start thinking with as we look at our retirement healthcare needs and benefits. If we were to take healthcare throughout our lives and created a step level that leads to our eventual end, it may look something like this:
- Traditional healthcare
- Medicare/Medicare Advantage
- Palliative care
- Hospice care
The word hospice has become a scary word to many. Upon hearing it, the first thought is death – it’s over. Forget that there are people who’ve stepped into hospice, improved, and returned to regular care. You see, sometimes people need hospice because regular treatment is making life unbearable, and help is needed to bring quality to living. Now, we have a middle ground, palliative care.
Palliative care is unknown to many, as it’s a new healthcare practice. It is a go-between regular care and hospice, due to the special needs required. This too is coming to Medicare Advantage, and it’s a welcomed addition. Let’s look at this a little deeper.
Chronic Care
When a person is diagnosed with a life-threatening illness (cancer, ESRD, chronic obstructive pulmonary disorder or [fill in the blank]), often the treatments’ side effects can be drastic enough to make one discouraged and lose hope. This loss of hope can lead to a premature death because they’ve lost the will to live.
Palliative Care
Before palliative care, hospice would be brought in to help ease the nausea, pain and other side effects, so as to alleviate the stress and provide hope. While hospice has tried to fill the need, that’s not what hospice was designed for. Hospice is supposed to be invoked only when one has a prognosis of six- or fewer months to live. Having to fill the void that existed for a go-between, would stretch hospice’s resources. And sometimes, as was the case with my mom when they approached me, upon hearing the word hospice, hope takes a serious blow.
However, palliative care is designed to add comfort and ease the side effects of life-sustaining treatment. By working with the doctors providing chemotherapy or other service, a plan is created to make it as bearable as possible. When the individual gets better, palliative care stops. If the person does not get better, then palliative care transitions into hospice care.
Having experience palliative care, I must say it’s a wonderful practice. The people truly go above and beyond to make a person comfortable and feel hope again. It’s like God sent His angels to care for those in need, wearing white, minus the halo and wings.
And it’s not just the patient who is cared for, the help it affords to family members is peace of mind, knowing they no longer have to do what they are not prepared to do. It’s a heavy burden that’s lifted. Often, this is provided from the comfort of one’s home.
One of the leaders in this transition is Humana, who is testing and innovating in order to offer the best experience and care possible. Other plans will start to add these services as testing nears completion.
So, as you start to hear about these services being added to Medicare Advantage, be encouraged. Strive to understand all your benefits and how they can best serve you. After all, while doctors, nurses and your insurance carrier strive to deliver the best care they can, ultimately it’s you who must decide.
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