Does Medicare cover 24-hour hospice care?
Having a loved one enter hospice care can be stressful, but knowing they are taken care of during their end of life can bring comfort to everyone involved. Hospice can include a range of services, but understanding the details can help you plan ahead.
Hospice care consists of specialized services administered under the following circumstances: You have an illness without a cure, your life expectancy is six months or less, and the objective of your care is symptom management and quality of life rather than treatment.
A dedicated interdisciplinary team of professionals specializing in hospice services develop a tailored plan of care, coordinate services, and offer support to family and friends serving as caregivers. During periodic visits to your home, the hospice team addresses physical, psychosocial and spiritual needs.
According to the Hospice Foundation of America, all Medicare beneficiaries are eligible for hospice coverage, and in almost every state, Medicaid coverage includes hospice benefits. Hospice service providers are available 24/7 if you or your caregiver needs help, but the cost of room and board in a nursing home or at a hospice center is not considered hospice care.
Medicare hospice care coverage
Part A covers hospice care for beneficiaries with a life expectancy of up to six months, contingent on a physician’s certification of terminal illness and life expectancy. You must sign an agreement that you choose hospice care in place of treatment. Should you need hospice care beyond six months, Medicare may approve an extension if the hospice medical director or doctor recertifies your terminal condition after a face-to-face meeting.
A Medicare-approved hospice agency will arrange care in your residence, including your private home or a nursing home. Medicare will not cover long-term room and board in a facility. Medicare may approve short-term inpatient care in a hospice center, hospital or skilled nursing facility to manage pain or other symptoms if your hospice medical team certifies the need. In that case, the facility must be Medicare-approved.
Medicare hospice care benefits
Medicare-approved hospice care is at no cost. Your hospice team develops a plan of care specific to your terminal condition. Based on the plan of care and the team’s recommendations, Medicare Part A covers:
- Pain management, including Medicare-covered drugs with a copayment of up to $5 per prescription
- Medical care, nursing and social services
- Services of a home health aide and homemaker
- Physical, occupational and speech-language therapy
- Durable medical equipment (DME)
- Spiritual and grief counseling
Caring for a terminally ill family member or friend is challenging. Medicare covers inpatient respite care, meaning the patient can stay at a Medicare-approved facility for hospice care, giving unpaid caregivers time to rest. Your cost is 5% of the Medicare-approved amount. Medicare does not publish the maximum number of times the inpatient respite care benefit is available, but Medicare caps the duration of each time at five days.
Hospice and Medicare Advantage
When you join a Medicare Advantage (MA) plan, you are still a Medicare beneficiary. Still, you receive most of your Part A and Part B benefits from your MA plan rather than Original Medicare. Hospice care is one of the exceptions. Whether or not you are an MA member, Original Medicare Part A covers your hospice care benefits.
To show the hospice agency your proof of insurance, present your Original Medicare ID (red, white and blue card). While your hospice agency will bill Original Medicare for hospice care, Medicare Advantage continues to pay for covered services unrelated to your terminal illness.
Hospice providers
You can find a list of Medicare-approved hospice care providers on medicare.gov. When you type your zip code, the search results display agencies that service your location, so don’t be concerned if the agency does not have an office in your immediate area.