Does Medicare Cover Hospice Care? Find Out If You're Covered
- Does Medicare cover hospice care? Learn about hospice care in Medicare, including how it works, the eligibility criteria and what's covered under the benefit.
People with a life-threatening condition may wonder if Medicare covers hospice care. The short answer is yes. For eligible people, hospice care is completely covered by Medicare.
Hospice care can be a great support if you have a terminal illness, providing assistance to help manage pain and symptoms. The focus of hospice care is on making you as comfortable as possible rather than attempting to cure your illness. Understanding the eligibility criteria for hospice care through Medicare, what’s covered and any payments required can help you make decisions about your future care.
When Does Medicare Cover Hospice Care?
There are a number of eligibility criteria for people who wish to receive hospice care through Medicare. First, a health care provider must state that you have less than six months to live. This certification should come from a hospice doctor and your regular doctor, if you have one.
In addition, you must sign a statement that you’re accepting hospice care for your illness instead of other treatments for the condition. The hospice benefit only covers palliative care, so you can’t pursue treatments intended to cure your illness. However, you can stop receiving hospice care at any time if you decide you want to receive those treatments.
The hospice benefit is available to people who have Medicare Part A, or hospital insurance, as well as those on a Medicare Advantage Plan. Care is only covered if the hospice provider is licensed by Medicare.
Which Part of Medicare Covers Hospice Care?
Hospice care is covered by Original Medicare, also known as Part A and Part B. However, people who have a Medicare Advantage Plan, known as Part C, also receive hospice care through original Medicare.
How Do Hospice Benefits Work?
When you decide to receive hospice care, you must first choose a hospice provider. Medicare’s website has a tool that lets you search for and compare hospice providers. Once you’ve made a selection, you’ll work with them, your family and other members of your team to set up a hospice plan of care. That team may include:
- Social workers
- Physical and occupational therapist
- Speech-language pathologists
- Hospice aides
The hospice provider then provides services according to the plan of care. The palliative care provider offers physical, emotional, social and spiritual support. They also provide assistance and support to your family.
What Does Medicare Cover for Hospice Care?
Medicare provides a one-time consultation with a hospice medical director or doctor. This lets you discuss your care options and methods available for managing pain and symptoms. This consultation is covered, even if you decide you don't want hospice care.
Once your benefit starts, it covers any care for your terminal illness or any related conditions. This includes physical care, counseling, drugs, equipment and supplies. Care is typically provided where you currently live, which lets you stay with your family in the comfort of your home. Inpatient care is covered if it’s needed, and your provider will make the arrangements.
The benefit doesn’t allow for 24-hour care in your home; caregiving is provided by your family when professionals aren’t there. However, a hospice nurse and doctor are on call around the clock to provide support when needed. The benefit also covers respite care if your caregiver needs a rest.
What Do I Pay for Hospice Care?
There are no copayments for the care provided through the hospice benefit; however, you do need to continue to pay monthly Medicare premiums. There is a copay of up to $5 per prescription for any drugs prescribed to manage pain and symptoms. If you receive inpatient respite care at any point, you need to pay 5% of the Medicare approved amount.
What Isn’t Covered?
Hospice benefits only cover treatments, drugs and equipment related to your terminal illness. This means that you need additional coverage for any medication or care that doesn’t arise from that condition. If you ask, your hospice provider must give you a list of what isn’t related to your terminal illness and explain why they made that determination.
As you must continue to pay Medicare premiums, most health care will still be covered. However, you may need prescription drug coverage for any medication. You also need to pay copays and deductions for anything not related to your terminal illness.
Medicare doesn’t cover room and board, but your stay will be covered if your hospice team organizes short-term inpatient care or respite services. Generally, any care that wasn’t set up by your hospice team won’t be covered. This can include inpatient and outpatient hospital visits and ambulance rides. It’s best to contact your hospice team before getting any of these services to ensure you don’t have to pay.
How Long Does Hospice Cover Last?
Although the benefit is only available to people with less than six months to live, Medicare does cover hospice care once those six months have passed. If you live longer than six months, you continue getting care as long as you’re recertified as being terminally ill.
Hospice care through Medicare is provided in benefit periods. There are two initial 90-day periods, followed by an unlimited number of 60-day benefit periods. To continue receiving care, your hospice provider must recertify you at the end of each period.
If your health improves or you go into remission, your hospice care stops. Your health insurance will return to normal Medicare. If you’ve continued paying Medicare Advantage premiums during your illness, you’ll revert to this plan. Otherwise, all health care will be provided through original Medicare.