Does Medicare Pay For Hospice Care?

Medicare beneficiaries with terminal illnesses can depend on Medicare to cover hospice care. Hospice care focuses on symptom management, pain relief, and emotional support for the patient and family. The individual must be enrolled in Medicare Part A and receive care from a Medicare-authorized hospice team. Once a person enrolls in hospice care, Medicare will pay most fees for core services, including nursing care, therapies, counseling, home care, and inpatient care.

Does Medicare cover hospice services?

Medicare does pay for hospice care, including personalized care, physician services, and medications related to your terminal illness. To qualify for the hospice benefit, you must meet these requirements:

• You must have Medicare Part A hospital insurance.
• Your hospice doctor and primary care physician (if you have one) must certify that you have a terminal illness and a life expectancy of six months or less.
• You must sign a statement to choose hospice care rather than treatments for curing your terminal illness.
• You must enroll in a Medicare-approved hospice program and follow your hospice team’s personalized plan of care (POC).

Original Medicare will cover these benefits even if you have Medicare Advantage (Part C) or another Medicare supplement plan. If you had another plan in place before choosing hospice care, your plan would remain active as long as you pay your premiums. Part C or supplemental plans may cover medical expenses unrelated to your terminal illness.

What are Medicare hospice benefits?

Medicare Part A covers most hospice benefits, which include services and items for controlling terminal disease symptoms and pain. The federal insurance program requires hospices to appoint an interdisciplinary group of health professionals to coordinate individualized services for each patient.

Plan of care (POC)

The designated group, along with your attending physician if you have one, must develop a plan of care (POC) regarding your hospice services. The POC must honor your and your family’s goals and include all services needed to manage your terminal illness and related conditions, which may involve:

• Services from doctors and nurse practitioners employed by a hospice or chosen by the patient.
• Short-term inpatient pain control, symptom management, and respite care.
• Grief and loss counseling for individual and/or family.
• Medications to manage pain and symptoms
• Physical, speech, and occupational therapy
• Home health and homemaker services
• Medical supplies and equipment
• Caregiver support and respite
• Medical social services
• Nutritional counseling
• Spiritual support
• Nursing care

Original Medicare may cover other reasonable, necessary hospice services as outlined in the patient’s POC.

Does Medicare cover 24-hour hospice care?

Medicare might cover 24-hour hospice care if the patient’s symptoms warrant constant supervision and aid. Nursing care may include skilled monitoring and skilled care to control pain and other symptoms.

Will Medicare cover 24-hour in-home hospice care?

Medicare may arrange continuous home care (CHC) briefly and only in a crisis as required to keep the hospice patient at home. A period of crisis happens when a patient needs continuous, mainly nursing services to ease or manage severe medical symptoms at home. This could occur if a patient’s family caregiver can or will not provide a skilled level of care for the patient.

CHC can be given in a long-term care facility. However, Medicare does not permit it to be furnished in a hospital, hospice inpatient unit, or skilled nursing facility.

Is hospice care for dementia covered by Medicare?

Medicare may cover hospice care for dementia if the individual has a prognosis of six months or less. Some Medicare contractors apply special rules regarding hospice coverage for individuals with dementia. A person with dementia can receive Medicare-authorized hospice services in the home, a hospital, residential care facility, or a hospice facility.

The possibility of a dementia diagnosis makes planning so important. End-of-life care decisions can be more complicated if individuals with a terminal illness can no longer express their needs and preferences for treatment or services.

What is not covered by Medicare?

Once your hospice benefit starts, Medicare will not cover:

• Treatments or drugs to cure your terminal illness.
• Care from any hospice provider not arranged by your hospice team.
• Room and board for care in any facility not approved for your hospice care.
• Care as a hospital outpatient or inpatient.
• Ambulance transportation not approved by your hospice team.

If your hospice care provider anticipates Medicare will not cover an item or service, they may give you an Advance Beneficiary Notice of Non-coverage (ABN). The ABN will provide the option to use any other insurance you may have. With this form, you can choose in advance to appeal charges made to you or be responsible for payment.

How much will hospice care cost with Medicare?

Original Medicare does not impose any deductibles or other additional costs for hospice care. You must still pay premiums for any Medicare plans you have, including Part A, Part B, and Part C (Medicare Advantage).

Patients or their families might be responsible for hospice coinsurance costs related to drugs and respite care.

Drugs and biologicals coinsurance

Hospices can charge for prescription drugs and biologicals to help manage the pain and symptoms of a person’s terminal illness. The coinsurance amount is 5% of the cost of the medication to the hospice, not to exceed $5 per prescription. The patient would owe no coinsurance if they received the drug during general inpatient care or respite care.

Respite care coinsurance

The patient’s daily coinsurance amount is 5% of the Medicare payment for a day of respite care. This amount cannot exceed the inpatient hospital deductible for the year the hospice coinsurance period started. This care includes costs for room and board. Respite care costs can change each year.

For how long does Medicare cover hospice care?

Medicare will cover hospice care for up to two 90-day periods. You can have an unlimited number of additional 60-day periods if you want further care and your hospice doctor approves it.

A benefit period begins the day your hospice care starts. It ends when your 90-day or 60-day period expires.

Your hospice doctor must confirm your terminal illness at the start of each period for Medicare to continue covering your hospice care benefits. However, you don’t need to choose hospice care again with each new period. You can change hospice providers once during each benefit period.

Medicare pays for a wide range of hospice services for those facing the end of life. Individuals with a terminal illness can receive extensive medical, emotional, and spiritual support and help from their caregivers. Hospice care can be provided in an individual’s residence or a Medicare-approved facility.