Hospice care is a special form of healthcare that focuses specifically on the quality and well-being of people at the end of life. The focus is on providing compassionate care to those suffering from incurable illness in its final stages so they can live as comfortably and as fully as possible.
The hospice philosophy acknowledges death as the final stage. For this reason, Medicare covers nearly all costs. Read on for a complete explanation and requirements for coverage.
Key Takeaways
- Hospice care is a medical care service that provides health care and comfort services for terminally ill patients.
- Medicare Part A covers the majority of costs for hospice benefits once the doctor determines the beneficiary is terminally ill.
- Terminally ill beneficiaries must be certified by a doctor to have 6 months or less to live for hospice eligibility.
- Medicare Part A will not cover treatments for your terminal illness while under hospice care.
- Respite care to provide your caregiver a break is covered by Medicare.
- Medicare Advantage plan members are still covered by Original Medicare (Part A and Part B) for hospice services.
- While hospice care coverage is for beneficiaries with six months to live, Medicare will continue coverage past six months if your doctor confirms you are still terminally ill.
How Does Hospice Care Work?
Hospice care involves a team of health care professionals providing a personal care plan for terminally ill patients. To be considered terminally ill, your doctor must give you a diagnosis of six months or less before you pass away due to your health condition.1Mayoclinic.org, “Hospice“, Accessed December 16, 2021
Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services:2Medicare.gov, “Medicare Hospice Benefits“, Accessed December 16, 2021
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Prescription drugs
- Hospice aide and homemaker services
- Physical therapy
- Speech-language pathology services
- Social worker services
- Dietary counseling
- Grief and loss counseling for you and your family
- Short-term inpatient care (for pain and symptom management)
- Short-term respite care
- Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team
How Does Medicare Cover Hospice Care?
Once your doctor has confirmed your terminal illness and diagnosis you with less than six months to live, you will receive a single consultation with a hospice medical director or hospice doctor. They will go over what your options are for a hospice care plan and which hospice agencies are approved by your Medicare coverage. When you decide to receive hospice care, Medicare Part A will cover all aspects of your hospice care plan provided by your hospice care team.2Medicare.gov, “Medicare Hospice Benefits“, Accessed December 16, 2021
When you agree to receive hospice care, you no longer receive treatment to cure your illness. You are agreeing to receive care for your comfort instead. You must sign a statement choosing hospice care instead of other Medicare benefits.3Medicare.gov, “Hospice care“, Accessed December 16, 2021
When your hospice care plan is covered by Medicare, you are fully covered for the services. The only things you will need to pay for within hospice care would be:2Medicare.gov, “Medicare Hospice Benefits“, Accessed December 16, 2021
- Any Medicare monthly premiums you may have.
- A copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
- Five percent of the Medicare-approved amount for inpatient respite care.
Medicare Coverage For Respite Care
You can get inpatient respite care in a Medicare-approved facility(such as a hospice inpatient facility, hospital, or nursing home) if your current caregiver or family member requires a break. You can arrange for this respite care with your hospice care provider. They will provide up to five days of respite care at a time on an occasional basis.2Medicare.gov, “Medicare Hospice Benefits“, Accessed December 16, 2021
What Doesn’t Medicare Cover For Hospice Care?
Medicare Part A will cover most services for your hospice care plan, but certain services are not covered. The following services are not covered while you are receiving hospice care:2Medicare.gov, “Medicare Hospice Benefits“, Accessed December 16, 2021
- Treatment intended to cure your terminal illness and/or related conditions.
- Prescription medications that are unrelated to your terminal illness.
- Hospice care services from any provider that wasn’t set up by your hospice medical team.
- Room and board, except in the specific case of short-term respite care (see “Medicare Coverage For Respite Care” above)
- Any ambulance transportations, hospital outpatient services, and hospital inpatient services that are not approved by your hospice team.
Will My Medicare Advantage Plan Cover Hospice Care?
You can use hospice care services and providers within your Medicare Advantage Plan‘s network. However, Original Medicare (Part A and Part B) will cover all expenses related to your terminal illness once your hospice benefit has begun.4Medicare.gov, “How hospice works“, Accessed December 16, 2021.
You can still use Medicare Advantage to cover non-hospice Medicare-approved services and any expanded services your Medicare Advantage Plan covers, as long as you continue to pay the monthly premiums. Be aware that if you decide to stop receiving hospice care, your Medicare Advantage Plan will not resume until the first day of the following month.4Medicare.gov, “How hospice works“, Accessed December 16, 2021
How Long Will Medicare Cover My Hospice Care?
While hospice care is supposed to be for people with an estimated six months left to live, you can still receive hospice care past that point. As long as your doctor recertifies you are still terminally ill, your hospice care will still be covered. However, your hospice care will end if your doctor determines you are no longer terminally ill.3Medicare.gov, “Hospice care“, Accessed December 16, 2021
Hospice care will also end if you have decided to resume treatment to cure your condition. You can restart your hospice care once you cease treating your terminal illness, but you will be required to get approval from your doctor and apply for hospice care from the beginning.3Medicare.gov, “Hospice care“, Accessed December 16, 2021
Summary
A terminal diagnosis is devastating for anyone to hear, in addition to all the treatments you need to optimize your remaining time and the affairs you need to get in order. Thankfully, Medicare will cover the majority of your hospice care with hardly any cost on your part. If your doctor tells you that you have a terminal illness, they will work with you to get the hospice care you need as soon as possible.
Citations
- 1Mayoclinic.org, “Hospice“, Accessed December 16, 2021
- 2Medicare.gov, “Medicare Hospice Benefits“, Accessed December 16, 2021
- 3Medicare.gov, “Hospice care“, Accessed December 16, 2021
- 4Medicare.gov, “How hospice works“, Accessed December 16, 2021