Will Medicare Cover Hospice Care and Services?
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Medicare will cover hospice care if you are enrolled in Part A of Original Medicare and have a terminal illness with a short life expectancy. Keep in mind that if you do choose coverage for hospice care, Medicare will no longer pay for curative treatment related to the terminal illness.
Learn what hospice care costs with Medicare as well as where you can receive hospice care.
What Type of Hospice Care Is Covered by Medicare?
Once you qualify for the Medicare hospice benefit, you will be covered for a range of hospice services and benefits:
You will also receive short-term inpatient care for pain and symptom management and inpatient respite care, which may give primary caregivers such as family members a chance to rest. Respite care can be received in a Medicare-approved facility for up to five days at a time but can also be received multiple times. The hospice provider will arrange for these services as recommended by the hospice team.
What Isn’t Covered?
The Medicare hospice benefit doesn't cover drugs of treatment for curing your illness, only those for managing symptoms and pain relief. The patient must choose coverage for hospice care at the cost of coverage for curative treatment. Your hospice team must provide all care for your terminal illness but you can still see your regular doctor.
If you get hospice care at home or in a facility, your Medicare plan won't cover room and board. But if the hospice team arranges short-term inpatient or respite care, Medicare will pay for it. A copayment will apply for respite care.
Also, hospice care doesn't cover hospital or ambulance costs unless arranged by your hospice team.
What if You’re in a Medicare Advantage Plan (Part C)?
Original Medicare Part A will cover all services related to your terminal illness even if you purchased a Medicare Advantage plan. You can still use your Medicare Advantage (MA) plan for services not related to your terminal illness or related conditions. If you decide to leave hospice care, your MA plan won't restart until the first day of the next month.
What Is Hospice Care?
Hospice care is a specialized form of medical care that focuses on improving the quality of life for people who have been diagnosed with terminal illnesses. There is a particular emphasis on palliative care, also called comfort care — the management of symptoms and pain associated with a terminal illness. It is intended to provide a terminally ill patiient with relief from discomfort via medication management, physical therapy, counseling and other therapies.
A hospice team can include doctors, nurses, social workers and chaplains and care can be delivered in a hospice facility or hospital. It is also possible for a patient to receive hospice care in their own home, which can provide comfort and reduce stress for both the patient and their loved ones.
How Do You Qualify for the Hospice Benefit Through Medicare?
To be eligible for the Medicare hospice benefit, you must be enrolled in Medicare Part A (hospital coverage). Your doctor and the hospice medical director must then certify that you have a terminal illness and that your life expectancy is six months or less if the disease runs its normal course (more on this below).
Additionally, the patient or their guardian must sign a statement choosing hospice care over other curative treatments for the terminal illness. Lastly, the patient must receive care from a Medicare-approved hospice program.
What Are the Four Levels of Hospice Care as Defined by Medicare?
The four levels of hospice care are defined as:
- Routine home care: This is the most common level of hospice care and it involves care being provided to the patient at their own home. Symptoms are usually under control.
- Continuous home care: Your symptoms/pain must constitute a crisis and involves continuous nursing care to manage acute symptoms that cannot be managed through routine care.
- Inpatient respite care: Caregivers are given a break at this level and it involves short-term care in a hospital or hospice inpatient facility for up to 5 days.
- General inpatient care: This level of care is provided when the patient's symptoms can no longer be managed at home and require more intensive care in a hospital or hospice inpatient facility.
How Much Does Hospice Cost With Medicare?
The Medicare hospice benefit is generally covered with no out-of-pocket cost to you, except for a copayment of up to $5 per prescription for outpatient drugs. If a drug is not covered, your provider will check if it is covered under Part D.
In addition, you may be responsible for up to 5% of the Medicare-approved amount for inpatient respite care. Nursing home residents will still need to pay for room and board if they choose hospice care.
Remember that to qualify for hospice care, you had to sign a statement that you chose hospice care in lieu of other Medicare-covered treatments for your terminal illness. That means Medicare will not cover medical treatments related to your terminal illness outside of hospice care.
How Long Can You Get Hospice Care Under Medicare?
Medicare provides hospice care to eligible patients with terminal illnesses and life expectancies of six months or less. Hospice care may be covered until the patient dies or if their condition stabilizes or improves.
Medicare-approved hospice providers are required to periodically evaluate the patient's condition and if they no longer meet the eligibility criteria, discuss other care options. Evaluations are typically face-to-face but can be done via telehealth due to COVID-19 until December 31, 2024.
Where Can You Get Hospice Care?
The hospice benefit lets you stay in your home with your family unless you need inpatient care. If your hospice team decides you need inpatient care, they'll need to assist with the transition. If you need to go to the hospital, your hospice provider must arrange it and cover the cost, which is paid directly to the healthcare facility. But if you go to the hospital without their arrangement, you may have to pay for the entire cost yourself.