Does Medicare cover hospice care?

What does Medicare hospice care include?

Hospice is end-of-life care for people with illnesses that can't be cured. Once you choose hospice care, your Medicare hospice benefit should cover everything you need, and you and your family work with your hospice care team to set up a plan of care. A hospice nurse and doctor are on call 24 hours a day, 7 days a week. Depending on your terminal illness and related conditions, your plan of care might include any or all of these services:

• Doctors' services, and nursing and medical services.
• Drugs for pain and symptom management.
• Durable medical equipment for pain relief and symptom management, and medical supplies, like bandages or catheters.
• Aide and homemaker services.
• Physical therapy, occupational therapy and speech-language pathology services.
• Dietary counseling and social services.
• Short-term inpatient care for pain and symptom management.
• Inpatient respite care for up to 5 days, which your hospice provider arranges; you can get it more than once, but only on an occasional basis.
• Spiritual and grief counseling for you and your family.

Who qualifies for Medicare hospice care?

You must have Part A and meet all of the conditions below. Before you get any hospice services, you sign a Hospice Election Statement, which names the hospice providing your care, the start date of your services and the attending doctor you choose.

• Your hospice doctor and your regular doctor (if you have one) certify that you're terminally ill, with a life expectancy of 6 months or less.
• You accept comfort care (palliative care) instead of care to cure your illness and related conditions.
• You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

What do I pay for hospice care?

You pay nothing for hospice care from a Medicare-approved hospice provider. You pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. You may pay 5% of the Medicare-approved amount for inpatient respite care (short-term care to help give caregivers a rest). Your copayment can't be more than the inpatient deductible amount.

Medicare doesn't cover room and board if you get hospice care in your home or live in a nursing home or a hospice inpatient facility, so you may pay for room and board if you live in a facility. If your hospice team decides you need short-term inpatient or respite care services that they arrange, Medicare covers your stay in the facility.

Original Medicare still pays for covered benefits for health problems that aren't part of your terminal illness and related conditions, but you owe any deductible and coinsurance that apply.

What won't Medicare cover once hospice starts?

Once your hospice benefit starts, Medicare won't cover any of the following. Contact your hospice team before you get any of these services, or you might have to pay the entire cost.

• Treatment intended to cure your terminal illness or related conditions, and prescription drugs to cure your illness (rather than for symptom control or pain relief).
• Care from a hospice provider that wasn't set up by the hospice medical team. You can still see your regular doctor or nurse practitioner if you've chosen that person as the attending medical professional who helps supervise your hospice care.
• Room and board at home, in a nursing home or in a hospice inpatient facility, unless your hospice team arranges short-term inpatient or respite care.
• Hospital outpatient care (like in an emergency room), hospital inpatient care or ambulance transportation, unless your hospice team arranges it or it's unrelated to your terminal illness and related conditions.

How long can I get hospice care, and can I stop?

If you qualify, Medicare covers hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. After 6 months, you can keep getting hospice care as long as the hospice medical director or hospice doctor recertifies, after a face-to-face meeting with the hospice doctor or hospice nurse practitioner, that you're still terminally ill. You can change your hospice provider once during each benefit period.

You can stop hospice care at any time, for example if your health improves or your illness goes into remission. You sign a form with the end date for your care, and your Original Medicare coverage (or your Medicare Advantage Plan, if you have one) starts again. No one from your hospice team should ask you to sign forms about stopping hospice care when you start hospice. If you qualify, you can go back to hospice care at any time.

Does Medicare Advantage or Medigap change hospice coverage?

If you're in a Medicare Advantage Plan or other Medicare health plan, Original Medicare covers everything you need related to your terminal illness once your hospice benefit starts, even if you stay in your plan. Your plan must help you find a Medicare-approved hospice provider in your area, can still cover services that aren't part of your terminal illness, and keeps covering any extra services it offers, like dental and vision benefits, as long as you keep paying your plan's premiums. If you leave hospice care, your plan starts again the first day of the following month. See how Medicare Advantage differs from Original Medicare.

Medigap policies help pay your share of costs in Original Medicare. Medigap Plans A, B, C, D, F, G, M and N pay the Part A hospice care coinsurance or copayment in full, Plan K pays 50% of it and Plan L pays 75%.