Does Medicare Cover Hospice Care and Who is Eligible?
Yes, Medicare covers hospice care. Both at-home and short-term inpatient hospice care are covered 100%, provided you meet some simple requirements. In this guide, we’ll go over those requirements, as well as what you need to know about hospice care under Medicare.
Who is eligible for hospice care under Medicare?
Anyone eligible for Medicare Part A is eligible for Medicare-covered hospice care. To qualify for Part A, you must be 65 or older and meet one of the following requirements:
- You receive Social Security or Railroad Retirement Board benefits.
- You are eligible for Social Security or Railroad Retirement Board benefits but aren’t receiving them.
- You or your spouse paid Medicare taxes during government employment.
If you’re under 65, you can still qualify for Medicare if you receive disability benefits or have End-Stage Renal Disease.
What are the requirements for hospice care?
To receive hospice care under Medicare, you must have Medicare Part A and meet a few additional requirements:
- Your hospice doctor and regular doctor both certify that you have a terminal illness and are expected to live less than six months.
- You choose to receive palliative care instead of treatment for your illness. Palliative care is designed to improve comfort and quality of life and relieve symptoms, rather than treat or cure an illness.
- You sign a statement choosing hospice care over other Medicare-approved treatments.
What hospice care costs are you responsible for?
When receiving hospice care under Medicare, all hospice costs are completely covered. However, patients may still be responsible for a $5 copayment for prescriptions. You may also be required to pay 5% of the Medicare-approved cost for inpatient respite care, should it be necessary. Respite care is a short inpatient stay intended to give your regular caregivers a chance to rest.
Medicare Part A, which is what covers hospice services, is free for most people. You can learn more about Medicare Part A on our site.
What hospice services are covered by Medicare?
Hospice care encompasses a wide variety of services designed to make the patient’s final months more comfortable:
- Doctor visits
- Skilled nursing care
- Prescription drugs that provide relief from pain and symptoms
- Short-term respite care
- Short-term inpatient care
- Medical supplies
- Spiritual care and counseling
- Grief counseling for both the patient and their family
In general, services will be covered as long as they are provided to improve quality of life rather than treat the illness. Hospice care is normally given to those with a life expectancy of six months or less, but Medicare will cover hospice care as long as it’s deemed necessary by your hospice doctor.
Medicare covers hospice care within benefit periods. The first two hospice benefit periods last for 90 days each. If care is still needed after 180 days, you will be covered for an indeterminate number of 60-day benefit periods. Again, you’re covered for hospice care as long as your hospice doctor certifies that it’s needed.
What hospice services are not covered by Medicare?
- Treatment intended to cure the terminal illness or related conditions: Hospice care is not intended to treat the terminal condition but to provide comfort and improve quality of life. If you decide you want to stop hospice care and begin treatment for your illness, you are free to do so at any time. The decision to start or stop hospice care is highly personal and should be discussed with your doctor.
- Medications intended to cure the illness: Only prescriptions for symptom control and pain relief are covered under Medicare hospice benefits.
- Room and board, either at home or in an inpatient hospice facility: Medicare will cover short-term stays in an inpatient hospice facility or respite care facility. But Medicare won’t cover long-term inpatient hospice care or room and board at any other location.
- Care from any hospice provider that wasn’t set up by your hospice team: All hospice care you receive has to be either given by your hospice team or arranged by them—you can’t get care from a different hospice provider unless you choose to change providers. You can still see your regular doctor if you select them to supervise your hospice care.
Does Medicare cover hospice in a skilled nursing facility?
Medicare will only pay for hospice in a skilled nursing facility on a short-term basis—and only if your hospice team decides it’s necessary. If you are already living in a nursing home, Medicare may cover the costs of hospice care but not the cost of room and board at the facility.
How does hospice work?
Hospice care is provided by a team of medical professionals, counselors, volunteers, and family members that work together to provide care for terminally ill patients during their final months. A hospice nurse and doctor are on call 24/7 to provide care and support for the patient and their family. The goal of hospice care is to make the patient as comfortable as possible. Their condition will not be treated.
The hospice team works together to decide on how to best care for the terminally ill patient. Once you enter hospice care, your hospice team must decide or approve all care plans in order for Medicare to cover them. There are thousands of hospice programs across the country. If you need help finding one, there are online directories you can use to compare programs.
For more answers to your Medicare questions, check out our other Medicare FAQs. You’ll find straightforward answers to common questions and in-depth guides on all aspects of Medicare.
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