Does Medicare Cover Hospice?
Although it’s difficult to think about, hospice care can be a source of comfort for families who are coping with a loved one’s end of life. The goal of hospice care is to provide your loved ones with peace, dignity, and comfort rather than curative treatment.
People on Medicare with a life expectancy of six months or less are eligible for hospice care. If you qualify for hospice care, you’ll pay nothing for hospice services.
While services are free, you do have to pay copays and coinsurance for prescription drugs and inpatient respite care. Also, Medicare won’t pay for room and board if you receive hospice care in a nursing home or other facility.
Key takeaways:
Medicare Part A covers hospice care under certain conditions for people with a life expectancy of six months or less.
Medicare covers the full cost of hospice services for those who qualify.
Out-of-pocket costs for hospice care include a 5% coinsurance for inpatient respite care and a copay of $5 for each prescription drug used to help manage symptoms.
Medicare won’t pay for room and board or any treatment to cure a terminal condition once your hospice benefit starts.
What is hospice care?
Hospice care is a form of specialized care for people who are at the end of their life. Rather than providing treatment that could result in a cure, hospice care focuses on making a person comfortable and content.
Hospice care typically includes:
Medical care
Symptom and pain management
Emotional and spiritual support
Family support and education
Grief counseling for families
Hospice care is often confused with palliative care or comfort care. Although all three types of care focus on a person’s comfort, palliative care and comfort care services can be for people who aren’t in the end-of-life stage.
Does Medicare cover hospice care?
Yes, Medicare Part A covers hospice care if you meet certain eligibility criteria that have to do with terminal illnesses or the end of life. You can receive Medicare coverage for hospice care received in your home, a nursing home, or other facilities—as long as you use a Medicare-certified hospice agency. However, Medicare may not pay for room and board if you live in a nursing home or other facility.
Medicare will also continue to pay for any medical services you need during hospice care, but your hospice benefit will usually cover everything.
Eligibility requirements for Medicare coverage of hospice care
To qualify for hospice care Medicare coverage, you have to meet all of the following conditions:
You must have a hospice doctor and regular doctor confirm that you have a terminal condition with a life expectancy of six months or less.
You have documented that you want hospice care rather than Medicare-covered treatments to cure a condition.
What won’t Medicare cover with hospice care?
Keep in mind that once you check all eligibility requirements and your hospice benefit starts, Medicare won’t pay for the following:
Treatment or prescription drugs intended to cure your condition
Emergency room and other hospital care
Ambulance transportation
Hospice care received outside of your chosen agency
Room and board
You and your family may want to talk to your hospice team before receiving any of these services to understand what they could cost.
Does Medicare Advantage cover hospice care?
Yes, Medicare Advantage plans will cover hospice care, but your out-of-pocket costs may be different. You may have to pay more or less for hospice services depending on your plan’s pricing details. Since copays, coinsurance, and deductibles are different for each Medicare Advantage plan, it’s best to check your summary of benefits or contact your insurance company for more information on hospice coverage.
What services Medicare covers for hospice care
Medicare has comprehensive coverage for hospice care services. A team of hospice healthcare providers will provide a plan for care that is specific to your condition and needs.
Services and equipment may include:
Doctor visits and advice
Nursing and medical aid
Any necessary medical equipment for pain relief and managing symptoms
Medical supplies
Aide and homemaker services
Therapy services, including physical therapy, occupational therapy, and speech-language pathology
Social services
Dietary counseling if necessary
Spiritual and grief counseling for beneficiaries and their families
Inpatient respite care so your usual caregiver can rest (see more details below)
Any other services you need or that your hospice team recommends to make you more comfortable
What you pay for hospice care with Medicare
There are two main costs under hospice care for outpatient prescription drugs and inpatient respite care.
Prescriptions for outpatient drugs:
Medicare beneficiaries will have to pay a copay of up to $5 for each prescription to manage pain and symptoms during hospice care.
It’s highly unusual that your hospice benefit wouldn’t cover a certain prescription. In this rare case, your hospice provider will contact your Part D insurance provider to see if the plan covers the drug. The hospice provider will coordinate any communication for payment so you and your family are informed.
Inpatient respite care:
It’s important for caregivers to take time and rest to regain their emotional and physical strength. Medicare covers inpatient respite care to give caregivers a break. Here’s what to expect for costs and other rules:
Depending on the inpatient facility, beneficiaries may pay 5% of the cost of care. This coinsurance can’t exceed the Part A deductible.
The hospice provider coordinates inpatient respite care.
Beneficiaries can receive inpatient respite care up to 5 consecutive days. It can happen more than once, but not frequently.
Hospice and end of life conversations are incredibly difficult. The last thing you want to worry about during this time is how much you’ll have to pay for hospice. Rest assured knowing that Medicare covers most of the costs of hospice, so you can focus on the comfort of you and your loved ones.