Does Medicare Cover Hospice?
Medicare covers hospice care when your doctor certifies you're terminally ill and you meet other requirements. Learn more about how Medicare covers hospice for you or your loved one.
Medicare covers hospice care if you have Medicare Part A, are certified by your doctor as terminally ill, you accept comfort (palliative) care instead of curative care and you sign a state choosing hospice care.
Learn more about Medicare benefits for receiving hospice care, such as Medicare-approved costs, hospice coverage details and more in this Medicare hospice benefit guide.
When Does Medicare Pay for Hospice Care?
To qualify for Medicare hospice benefits under Part A, there are specific criteria that must be met when you receive hospice care:
- You must be enrolled in Medicare Part A (hospital insurance).
- Your doctor and the hospice medical director must certify that you have a terminal illness with a life expectancy of six months or less if your illness runs its normal course.
- You choose to receive palliative care for your terminal illness.
- You sign a statement choosing Medicare-covered hospice care instead of other Medicare-covered treatments related to your terminal condition.
What Medicare Hospice Care Services Are Covered?
Once eligible, Medicare covers various services necessary to manage pain and symptoms associated with the terminal condition a hospice patient is living with.
Medicare hospice coverage benefits include:
- Nursing Services
Skilled nursing visits from registered nurses or licensed practical/vocational nurses provide symptom management and medication administration as needed.
- Hospice Physician Services
Consultations with physicians who specialize in end-of-life care can help develop an individualized plan tailored specifically to each patient's needs.
- Medical Equipment and Supplies
Items such as hospital beds, wheelchairs or oxygen equipment are covered when deemed medically necessary by the hospice team.
- Counseling Services
Emotional support from social workers, chaplains, bereavement counselors and other members of the hospice team can help hospice patients and their families cope with the emotional challenges of end-of-life care.
In addition to these services, Medicare may also cover short-term inpatient care for pain management or respite care for caregivers.
It's important to note that while Medicare Part A covers most hospice costs, there may be some out-of-pocket expenses for medications or other services not directly related to your terminal illness.
- You may pay 5% of the Medicare-approved amount if you receive care from an inpatient hospice program.
- You'll typically pay a copay of up to $5 for outpatient drugs used to relieve your pain and manage symptoms while using your Medicare hospice benefits.
Palliative Care vs. Hospice Care
When facing the end of life, it is essential to understand the various care options available through Medicare.
Two primary choices for seniors are palliative care and hospice care. Both offer support and comfort during a difficult time but differ in their goals and services provided.
Palliative care focuses on providing relief from symptoms, pain and stress associated with serious illnesses. Palliative care is intended to improve the quality of life for those affected by serious illnesses, providing relief from physical symptoms and emotional stressors.
Palliative care can be offered alongside curative treatments at any stage of illness.
- Does Medicare cover palliative care?
Medicare Part B can cover palliative care services such as doctor visits, nursing services, counseling sessions, and medications for symptom management or pain relief.
- Who's eligible for Medicare palliative care?
There are no specific eligibility requirements. You must have a qualifying medical condition, however, that requires this type of specialized treatment.
In contrast to palliative care's focus on managing symptoms while pursuing curative treatments, hospice care is designed specifically for individuals who have a terminal diagnosis with an estimated prognosis of six months or less if the disease follows its typical course.
Hospice emphasizes comfort measures rather than aggressive interventions aimed at curing illness.
Talk with your health care provider and a hospice medical team to learn which types of services and Medicare coverage best fits your circumstances.
What Excludes a Patient from Hospice Under Medicare?
A patient may be excluded from hospice care under Medicare if they do not meet the eligibility criteria, which includes having a terminal illness with a life expectancy of six months or less and choosing palliative care over curative treatment.
Additionally, patients must receive care from Medicare-approved hospice providers.
Is Medicare Always Primary for Hospice?
No, Medicare is not always primary for hospice. If the beneficiary has other insurance coverage such as Medicaid or private insurance, coordination between different payers will determine which one is the primary payer for covered hospice services and which insurance coverage is the secondary payer.
Depending on your situation, Medicare may serve as the secondary payer after your primary insurance coverage is used.
What Are the Four Levels of Hospice Care as Defined by Medicare?
The four levels of hospice care defined by Medicare include:
- Routine Home Care - The standard level of care provided at home or in an assisted living facility
- Continuous Home Care - More intensive support during periods of crisis to manage acute symptoms
- Inpatient Respite Care - Short-term relief for caregivers through temporary hospitalization
- General Inpatient Care - Advanced symptom management requiring hospitalization or skilled nursing facility stay
What Is Usually Not Included in Hospice Care?
Hospice care generally does not cover treatments aimed at curing terminal illnesses or any unrelated conditions.
This includes aggressive therapies like chemotherapy and radiation, prescription medications for curative purposes and hospitalization or emergency room visits unrelated to the terminal illness.
All Medicare Advantage (Medicare Part C) plans cover the same benefits as Medicare Part A and Part B, and plans may offer additional benefits Original Medicare (Part A and Part B) doesn't cover.