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Does Medicare cover hospice care?

Tuesday Nolden by Tuesday Nolden | Licensed since 2012
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This article was updated on: 11/17/2016

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Dealing with a terminal illness is a difficult enough experience without having to worry about pain management, medication costs, and assistance with caregiving. If you’re considering hospice care for yourself or a loved one, you may be comforted to know that Medicare’s hospice benefit is available to help eligible terminally ill beneficiaries and their families with these end-of-life issues.

How hospice care works

Unlike traditional care that seeks to cure the disease, hospice care focuses on maximizing the quality of life by providing comfort and support services.  Hospice care involves a core interdisciplinary team of professionals and caregivers who provide medical, psychological, and spiritual support tailored to the terminally ill person’s needs and wishes as well as support for the family. Your hospice team can include physicians, nurses, social workers, home care aides, counselors and volunteers, as long it’s a Medicare-approved hospice organization that provides them.  A hospice doctor is part of your medical team. Your regular doctor or nurse practitioner can also be part of this team. Furthermore, a hospice nurse and doctor are typically on call 24 hours a day, 7 days a week to give you and your family support and care when you need it.

As the Hospice Association of America (HAA) explains, “hospice is not a place, but a concept of care.” In the United States, hospice services are often based in the home, enabling families to be together sharing their final days in comfort and dignity, according to the HAA.  When home-care services are not an option, inpatient care is available from a Medicare-approved hospital, skilled nursing facility, or hospice inpatient facility.  Your hospice doctor can also arrange for inpatient care for temporary circumstances.  For example, occasionally you may be able to get inpatient respite care for up to five days in a Medicare-approved facility if a family member who is your usual caregiver needs a rest. Your hospice doctor can arrange this for you.

When to consider hospice care

Hospice care is an option to consider at the time your doctor renders a terminal prognosis, regardless of your diagnosis or physical condition.  You have the right to determine when you feel hospice is appropriate (instead of continuing to treat your health condition) and which Medicare-approved program suits your needs. Before you enter a hospice care program, however, a Medicare-assigned doctor must certify that you’ve been diagnosed with a terminal illness and have a life expectancy of six months or less if the illness runs its normal course. When trying to make this difficult decision, you may want to discuss it with your doctor, who can explain the probable implications of pursuing traditional curative care or hospice care, and with family members.

Hospice services covered by Medicare

You can receive hospice benefits under Original Medicare Part A when you meet these conditions:

  • You’re eligible for Original Medicare Part A (hospital insurance).
  • Your doctor and the hospice medical director certify that you’re terminally ill and have six months or less to live if your illness runs its normal course. (You can be re-certified for hospice care by your hospice doctor as needed or you can withdraw from the hospice program and return to your former Medicare coverage if your condition goes into remission.)
  • You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness. (Medicare may still pay for covered benefits for any health problems that aren’t related to your terminal illness.)
  • You get care from a Medicare-approved hospice program.

Hospice services that Medicare typically covers when they’re needed to care for your terminal illness and related condition(s) include:

  • Physician services
  • Nursing care
  • Medical supplies (such as catheters) and equipment (such as walkers)
  • Prescription drugs for symptom control and pain relief (you may have to pay a $5 copayment)
  • Nutritional counseling; social worker services; and grief counseling for you and your family
  • Hospice aide and homemaker services
  • Short-term inpatient care (for pain and symptom management)
  • Short-term respite care (you may need to pay a small copayment)
  • Other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team

All Medicare-covered services you get while in hospice care are generally covered under Original Medicare, even Medicare-covered services for conditions unrelated to your terminal illness. This is true even if you’re enrolled in a Medicare Advantage plan or other Medicare health plan. A Medicare Advantage plan is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Medicare Part A and Medicare Part B benefits. Hospice care is covered directly by Original Medicare when you have a Medicare Advantage plan; unlike other Part A and Part B benefits, your Medicare Advantage plan doesn’t provide this care. However, if your plan covers additional services not covered by Original Medicare (such as dental and vision benefits), your plan will continue to cover these additional services. For more information, you may want to read the publication, “Your Medicare Coverage: Hospice & Respite Care.”

If you would like to learn more about your Medicare coverage and options, I would be pleased to help you.

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This website and its contents are for informational purposes only. Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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