Medicare Supplement Plans and Hospice Care
This article was updated on: 09/16/2018
Medicare’s hospice care benefit is for beneficiaries with terminal illness whose doctors have certified that they have six months or less to live. Whether you’re considering hospice care for yourself or for a loved one, the decision to enter hospice care is a difficult one, and it’s a good idea to discuss any questions you may have with your doctor and health-care team.
This article gives you an overview of Medicare’s hospice care coverage, including how Medicare Supplement (Medigap) plans may help with certain costs, so you can make sure you’re getting all the support you need.
Medicare and hospice care coverage
Medicare covers hospice care if you’re enrolled in Part A and your doctor certifies that you have six months or less to live. If you decide to get hospice care, you’re agreeing to receive palliative (for comfort) care, and you’ll no longer receive treatment intended to cure your terminal illness. The goal of hospice care is to keep you comfortable and manage your symptoms, not treat your condition. You have the right to stop hospice care at any time to return to curative treatment.
Medicare’s hospice care coverage includes:
- Doctor and nursing services
- Medical equipment
- Hospice aide services
- Homemaker services
- Prescription medications for pain relief or symptom management
- Short-term respite care
- Short-term inpatient care (for pain relief or symptom management)
This article goes in more detail if you’d like more information on Medicare’s hospice benefit.
Although most hospice care costs are covered under Medicare, there are still some costs you may be responsible for. Depending on your situation and the type of care you need, your costs could include:
- 5% of the Medicare-approved amount for inpatient respite care
- Copayment of no more than $5 for each prescription medication (for pain relief or symptom management)
- Housing costs if you get hospice care where you live (for example, your home or an assisted living facility)
How Medicare Supplement plans help with hospice care costs
As mentioned, most of your hospice care costs are covered under Original Medicare. However, you may still owe a copayment or coinsurance in some situations. That’s where Medicare Supplement coverage may be helpful.
If you’re in hospice care in an inpatient setting (such as a hospital or skilled nursing facility), Medicare covers limited respite care, and you’re responsible for paying 5% of the Medicare-approved amount for this care. All of the 10 standardized Medicare Supplement plans available in most states offer coverage for this respite care coinsurance; Medigap Plans K and L cover 50% and 75% of the coinsurance cost, while the other eight Medigap plans cover 100% of the cost. Wisconsin, Minnesota, and Massachusetts have their own standardized Medicare Supplement plans.
When it comes to prescription drug costs, most of the medications your doctor prescribes might be covered under Medicare’s hospice benefit, but you may owe a copayment in some cases of no more than $5 per medication. All of the 10 standardized Medicare Supplement plans offer either partial or full coverage for copayment costs for prescription drugs you’re prescribed as part of your hospice care (that is, medications for symptom control or pain relief).
If a medication you need isn’t covered under Part A, contact your Medicare Prescription Drug Plan to find out if the prescription drug is covered through Part D. Medicare Supplement plans don’t cover prescription drug costs for medications under Part D.
If you’d like to learn more, I’d be happy to answer any questions you may have. To schedule a phone call to discuss your Medicare needs, click the link below. If you like, I can also send you personalized plan options tailored for your situation; you’ll find the link to do that below as well. To take a look at plan options in your zip code, click the Compare Plans button on this page.
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