Hospice provides palliative care for terminally ill patients as well as support for family members. It focuses on providing comfort, pain relief, and quality of life services when curative care is no longer an option.
Enrolling in hospice is a very stressful undertaking for eligible patients and their families. That’s why it’s important to understand how Medicare covers hospice care and how you and your family could get support from health care providers during this time.
Who is eligible for Medicare coverage of hospice care?
If you qualify for Medicare, Part A (inpatient hospital insurance) helps cover hospice care. Even if you have coverage with a Medicare Advantage (Part C) plan, hospice care is covered by Medicare Part A.
In order to be admitted into hospice care, you must also meet each of the following conditions for eligibility:
- Your regular doctor and the hospice doctor must certify that you are terminally ill with a life expectancy of six months or less.
- You must agree to palliative care instead of curative care for your illness.
- You must sign a statement declaring that you agree to receive hospice care rather than care meant to treat your illness and other conditions related to your terminal illness.
Medicare hospice coverage
If you qualify for hospice care through your Medicare benefits, you can get your care services in your own home, in a Medicare-affiliated nursing home, or in a hospice facility that accepts Medicare assignment.
Medicare also covers any other (covered) medical services you may need during hospice care for other medical issues not related to the terminal illness.
Hospice care services are provided by a team of medical professionals. When you enroll, they create a care plan for you that can include the following services:
- Physician care
- Skilled nursing care
- The supply of any durable medical equipment necessary to relieve pain and symptoms of your illness
- Medical supplies including catheters and others
- Drugs necessary for pain management
- Nurse’s aide care
- The assistance of a homemaker
- Physical or occupational therapies and speech-language pathology care
- Social services
- Diet and nutrition assistance
- Spiritual and grief counseling
- Inpatient care related to pain and symptom management if it’s required on a short-term basis, and if it’s provided in a facility that accepts Medicare assignment.
- Inpatient respite care that’s provided in a hospice facility that accepts Medicare assignment. Respite care is provided to allow your main caregiver to get a rest. It should be arranged by your hospice provider. Your main caregiver can get respite care for up to five consecutive days. You can get this benefit more than once, but only on an occasional basis.
- Miscellaneous services
When you enroll in a hospice program, your Medicare benefits no longer cover the following health care services:
- Curative care services related to your terminal illness or associated conditions.
- Prescription drugs meant to cure your terminal illness or any associated conditions.
- Hospice care from a provider that hasn’t been arranged by your hospice team.
- Paid room and board either in your home, or in another facility that you consider to be your home.
- Hospital outpatient care, hospital inpatient care, and transportation by ambulance apart from what is arranged by your hospice team, or for necessary treatment for conditions unrelated to your terminal illness or associated conditions.
Does Medicare cover all hospice expenses?
Original Medicare Part A covers 100 percent of hospice care, and beneficiaries don’t pay a Part A deductible or coinsurance. You are responsible for copayments (up to $5.00) for each prescription for outpatient drugs that are needed for pain and the management of symptoms related to your terminal illness. Original Medicare Part A pays for 95 percent of the current rate for inpatient respite care. You are responsible for the remaining 5 percent.