Medicare Hospice Benefit
When a person chooses hospice care, they’ve decided they no longer want care to cure their terminal illness and/or the person’s doctor has determined that efforts to cure the illness aren’t working. Medicare hospice benefits are available to those who meet all of these conditions:
- Eligible for Medicare Part A (Hospital Insurance).
- Certification of terminal illness by physician and hospice medical director with prognosis of 6 months or less to live if illness runs its normal course.
- Sign a statement choosing hospice care instead of other Medicare-covered benefits to treat patient’s terminal illness. (Medicare will still pay for covered benefits for any health problems that aren’t related to the terminal illness.)
- Care is received from a Medicare-approved hospice program.
What does Medicare cover?
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Drugs for symptom control or pain relief (may need to pay a small copayment)
- Hospice aide and homemaker services
- Physical and occupational therapy
- Speech-language pathology services
- Social worker services
- Dietary counseling
- Grief and loss counseling for patient and family
- Short-term inpatient care (for pain and symptom management)
- Short-term respite care (may need to pay a small copayment)
- Any other Medicare-covered services needed to manage pain and other symptoms related to the terminal illness, as recommended by the hospice team
If the patient’s usual caregiver (like a family member) needs a rest, a patient can get inpatient respite care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home). The hospice provider will arrange this for the patient. A patient can stay up to 5 days each time they get respite care. A patient can get respite care more than once, but it can only be provided on an occasional basis.
What Medicare doesn’t cover
- Treatment intended to cure the terminal illness. A hospice patient always has the right to stop hospice care at any time.
- Prescription drugs to cure an illness (rather than for symptom control or pain relief)
- Care from any hospice provider that wasn’t set up by the hospice medical team (A person must get hospice care from the hospice provider they chose. All care received for a terminal illness must be given by or arranged by the hospice team. A person cannot get the same type of hospice care from a different provider, unless the person changes the hospice provider. However, a person can still see their regular doctor if they’ve chosen him or her to be the attending medical professional who helps supervise the person’s hospice care.)
- Room and board (Medicare doesn’t cover room and board if hospice care is received in the home or if the person resides in a nursing home or a hospice inpatient facility. However, if the hospice team determines that short-term inpatient or respite care services are needed and the hospice team will arrange them, Medicare will cover the stay in the facility. The patient/family may have to pay a small copayment for the respite stay.)
- Care in an emergency room, inpatient facility care, or ambulance transportation, unless it’s either arranged by the hospice team or is unrelated to the terminal illness. It’s important to contact the hospice team before receiving any of these services or as the patient/family might have to pay the entire cost.
What a person pays for hospice care
Medicare pays the hospice provider for hospice care. There’s no deductible. A patient/family will pay:
- No more than $5 for each prescription drug and other similar products for pain relief and symptom control.
- 5% of the Medicare-approved amount for inpatient respite care.
For example, if Medicare pays $100 per day for inpatient respite care, the patient/family will pay $5 per day. The amount paid for respite care can change each year.
Go to the Centers for Medicare and Medicaid Services’ website to view “Medicare Hospice Benefits” pamphlet.