Does Medicare Cover Hospice?
Medicare covers hospice services for the terminally ill. To qualify, at least one doctor must certify you as terminally ill with a life expectancy of six months or less. In 2017, nearly 1.5 million Medicare beneficiaries received hospice services.
Hospice care focuses on the quality of life for people with terminal illnesses. It is meant to provide comfort and compassion for those in the final phases of incurable diseases.
Many people who receive hospice care have cancer. Others may have kidney failure, heart disease, dementia or chronic obstructive pulmonary disease.
Hospice care is most often utilized by patients who have exhausted all other treatment options.
People enrolled in Medicare must meet certain requirements to receive the hospice benefit.
- Get your hospice doctor and your regular doctor — if you have one — to certify that you are terminally ill with a life expectancy of six months or less.
- Accept comfort care — also known as palliative care — instead of care meant to cure your disease.
- Sign a statement electing hospice care to manage your terminal illness.
Hospice Coverage with Medicare
All hospice-related services are covered under Medicare Part A.
If you are enrolled in a Medicare Advantage (Part C) plan, these services are also covered.
If you were in a Medicare Advantage plan before your hospice care began, you can stay in that plan.
- Doctor visits
- Nursing care
- Hospice aide and homemaker services
- Prescription drugs for symptom control and pain relief
- Physical and occupational therapy
- Social work services
- Dietary counseling
- Medical equipment and supplies
- Grief counseling for you and your family
- Short-term respite care (if a family member or caregiver needs rest, you can get inpatient respite care in a Medicare-approved facility)
- Short-term inpatient care for pain and symptom management
While Medicare covers an extensive list of hospice care services, there are a few notable rules and exceptions.
Any care you receive must be arranged or administered by your designated hospice medical team.
To receive care from a different hospice, you must change your hospice provider.
You can still see your regular doctor if you select them as the attending medical professional who supervises your hospice care.
If you want to receive treatment to help cure your terminal illness, you cannot do so as a hospice patient. However, you have the right to stop hospice care at any time.
Likewise, prescription drugs meant to cure your disease instead of merely managing symptoms or providing pain relief may or may not be covered by Medicare.
Medicare does not cover room and board if you live in a nursing home or a hospice inpatient facility. However, some short-term inpatient care may be covered.
Finally, emergency room visits and ambulance transportation are only covered if these services are arranged by your hospice team or are unrelated to your terminal illness.
Medicare Costs for Hospice Care
Thankfully for patients and their families, there is little to no cost for Medicare hospice.
- No more than a $5 copayment for each prescription drug used for pain relief or symptom control while you're at home.
- Up to 5 percent of the Medicare-approved amount for inpatient respite care.
It is also important to note that your monthly Medicare Part B premium doesn’t go away once you start hospice care. You will need to continue paying this each month.
If you have a Medicare Advantage plan, you will also need to continue paying those premiums, unless you decide to drop the policy and stick exclusively with Original Medicare (Parts A and B).
5 Cited Research Articles
- American Cancer Society. (2019, May 10). What is Hospice Care? Retrieved from https://www.cancer.org/treatment/end-of-life-care/hospice-care/what-is-hospice-care.html
- Mayo Clinic. (2019, January 30). Hospice care: Comforting the terminally ill. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/hospice-care/art-20048050
- Centers for Medicare & Medicaid Services. (n.d.). Medicare Hospice Benefits. Retrieved from https://www.medicare.gov/Pubs/pdf/02154-medicare-hospice-benefits.pdf
- Medicare.gov. (n.d.). Hospice Care Coverage. Retrieved from https://www.medicare.gov/coverage/hospice-care
- Medicare.gov. (n.d.). How hospice works. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-a-covers/how-hospice-works