Is Hospice Covered By Medicare?

Is Hospice Covered By Medicare?

There has been a lot of talk recently about dying with dignity — and with good reason. Everyone deserves comfort and ease as they transition out of this life. That’s precisely the purpose of hospice care, which refers to services provided to someone with six months or less to live. Hospice means there’s no cure, and the person is unlikely to recover.

Hospice providers help the patient and their family by addressing a dying person’s physical, emotional, and spiritual needs. If a chronically ill senior is eligible for Medicare, their hospice care might be covered under this program. Here’s a summary of what you need to know about hospice and Medicare coverage so that you can plan accordingly. 

What Are the Medicare Requirements for Hospice Coverage?

Patients can get hospice care benefits if they meet the following criteria:

• They have Medicare Part A (hospital insurance).

• A hospice medical director (and the senior’s primary care doctor) must certify they’re terminally ill and have a life expectancy of six months or less.

• A Medicare-approved hospice provider must provide care.

What Hospice Services Does Medicare Cover?

Hospice providers offer many services that benefit patients and their families. Here are a few that might be covered at least in part by Medicare:

• Doctor services

• Nursing care

• Durable medical equipment (e.g., wheelchairs, walkers)

• Medical supplies (e.g., bandages, catheters)

• Prescription drugs for symptom control or pain relief

• Nutritional/dietary counseling

• Aide and homemaker services

• Physical and occupational therapy services

• Social work services

• Grief and loss counseling for both the patient and their family

• Short-term inpatient care for pain and symptom management

• Short-term inpatient respite care

• Any other Medicare-covered services recommended by the hospice team

If you have specific questions about Medicare coverage and hospice, it’s best to consult with your loved one’s care team. 

Does Hospice Offer Respite Care for Caregivers?

Caring for a seriously ill loved one in their final days can take its toll physically and emotionally. For this reason, you might be happy to learn that Medicare Part A covers short-term, inpatient respite care. This service allows a terminally ill person to continue receiving hospice care at a Medicare-approved hospice center, skilled nursing facility, or hospital so their caregiver can rest. Inpatient respite may last up to five days but a copay may be required to cover the patient’s room and board during their stay. 

What Doesn’t Medicare Cover For Hospice Patients?

If a Medicare beneficiary qualifies for and elects to receive hospice care, the following items and services will not be covered:

• Treatment intended to cure a terminal illness

• Prescription drugs to cure terminal illness

• Room and board

• Emergency care

• Ambulance transportation 

• Care a patient receives in an emergency room

• Care received as a hospital inpatient

What Are Your Hospice Care Costs with Medicare?

Most Medicare beneficiaries pay little to nothing for hospice care. However, in some situations, they might be responsible for the following:

• Prescription co-pays: A patient will pay at most $5 for each prescription drug and related products to maintain their quality of life. If a specific hospice benefit does not cover a particular medication, the provider will contact the patient’s Part D prescription drug plan on their behalf.

• Five percent of the Medicare-approved inpatient respite care costs: Medicare negotiates fixed rates with participating doctors and vendors. For example, if the approved expense is $100 per day for inpatient respite care, then the patient can expect to pay $5 per day.

How Long Will Medicare Pay For Hospice Care?

Hospice is intended for people who have six months or less to live. However, it can be challenging to determine how much time a person has left. For this reason, the Medicare hospice benefit is broken down into two 90-day benefit periods followed by an unlimited number of 60-day benefit periods, if needed.

The good news is that a person can continue receiving covered hospice care at the end of their life if the attending doctor certifies that they have six months or less to live. Some people retain their terminal status yet outlive the original projections and remain under hospice care for many months or even years.

There are some other guidelines to keep in mind. For example, a patient must be certified as having six months to live before the services can begin and be recertified at the start of each new benefit period. In addition, before starting their third benefit period (day 180 of hospice), an in-person consultation with a hospice doctor is required to recertify their eligibility. These recertifications are needed before each subsequent 60-day benefit period and must occur no earlier than 30 days before the new benefit period.

Have Questions?

Whether it’s a short-term, chronic, or terminal illness, caring for a loved one’s needs is a labor of love — but you don’t have to do it alone. Carewell is here to help. If you need help finding the perfect product or need someone to talk to, call (800) 696-CARE or email  support@carewell.com to speak with one of our Caregiving Specialists. We’re here to support you, 24 hours a day, 7 days a week.