What is Hospice Care?
This article was updated on: 09/15/2018
It might comfort you to know that Medicare may cover hospice care if you or a loved one has a terminal illness – that is, if your doctor has determined that your condition won’t improve and that your life expectancy is six months or less.
Hospice care is not treatment to try to cure your illness, according to the Centers for Medicare & Medicaid Services (CMS). Rather, its aim is to keep you comfortable, providing coordinated services that may include physical, social, emotional, and spiritual care for you, and support for your loved ones. Hospice care may also include prescription drugs to help manage your symptoms, such as pain.
What is hospice care coverage under Medicare?
In general, you may qualify for Medicare coverage of hospice care if all of these are true:
- You’re enrolled in Medicare Part A.
- Your hospice doctor and your regular physician or nurse practitioner, if you have one, have determined that you have a terminal illness and are not expected to live longer than six months.
- You state in writing that you’re choosing hospice care instead of other Medicare-covered treatments for your illness.
Hospice care is often provided in the terminally ill person’s home, but there are also hospice care facilities. The comfort of being at home, rather than at a facility, during hospice care may be important to a person with a terminal illness.
What hospice services does Medicare cover?
Medicare Part A typically covers hospice care services (related to your particular needs), which might include:
- Doctor services
- Nursing care
- Prescription medication for pain and symptoms
- Physical, occupational, and speech therapy
- Nutrition counseling
- Grief counseling
- Short-term inpatient care for pain and symptoms
- Medical supplies and equipment
- Hospice aide services
- Homemaker services such as laundry and cleaning
- Social worker services
- Short-term respite care to relieve caregiver(s)
The services and items listed above may not be a complete list. Your hospice team may work with Medicare to provide other covered services as needed.
What hospice services does Medicare not cover?
- Hospice care under Medicare Part A typically doesn’t cover prescription medications and medical treatment for curing the terminal illness. Please note that the patient can cancel the hospice care at any time.
- Prescription drugs intended to treat your illness, rather than relieve symptoms
- Room and board, whether you receive hospice care at home or in a hospital or other facility. However, Medicare may cover a short-term stay in a facility if your caregiver needs a short break (“respite care”). You may need to make a copayment.
- Inpatient or outpatient treatment at a hospital, or ambulance transportation. However, Medicare may cover these services if the hospice team arranges them or if they’re not related to your terminal illness.
- Any care that is not set up or provided by your hospice team is not covered. Medicare typically only covers the hospice care coordinated by the hospice team you selected. If you decide to get some similar care from a different hospice provider, Medicare usually won’t cover it. However, if your primary care provider is the attending physician that oversees your hospice team, Medicare will generally cover doctor visits with him or her.
How much will I pay for hospice care under Medicare?
You usually don’t have to pay anything for Medicare-covered hospice care, except:
- You may be responsible for paying no more than $5 for each prescription drug for pain relief and symptom control.
- You may have to pay a 5% coinsurance of the Medicare-approved amount for respite care, if needed.
What is hospice care coverage if I have a Medicare Advantage plan?
If you have a Medicare Advantage plan, you get your Medicare Part A and Part B benefits through the plan. The exception is hospice care. You’re still covered under Part A in the same way as described above.
What’s different is that if you decide to receive covered medical care that’s not related to your terminal illness, you can usually still do so under your Medicare Advantage plan.
If you want to stay in the Medicare Advantage plan, you’ll need to keep paying any premium the plan charges, as well as the Part B premium, as you’ve been doing.
Do you have questions about Medicare and hospice care? I’d be happy to help you.
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