Does Medicare Pay for Hospice In a Skilled Nursing Facility?
Medicare covers hospice care for people with terminal illnesses, including those living in skilled nursing facilities. If your doctor has recommended hospice care, you'll be relieved to know that Medicare's hospice benefit covers 100% of hospice services.
Medicare's hospice benefit provides coverage in various settings, including skilled nursing facilities, hospice facilities, assisted living communities, and at home.
We understand that discussing hospice care can be overwhelming, especially when you're focused on supporting a loved one. This guide explains how Medicare covers hospice care in skilled nursing facilities and what you can expect in terms of costs.
Key Takeaways
Under Original Medicare, patients with a life expectancy of six months or less can receive 100% hospice care coverage in various settings, including skilled nursing facilities.
Hospice care does not cover room and board expenses at skilled nursing facilities or hospice care centers—with an exception for five-day respite care periods.
Medicare pays for hospice care in two 90-day benefit periods, followed by unlimited 60-day periods, as long as patients continue to meet the eligibility requirements.
How Medicare covers hospice care
Anyone with Medicare Part A can get hospice benefits if they meet the eligibility requirements.
To be eligible for Medicare to cover hospice costs, a beneficiary must:
Be terminally ill with a life expectancy of six months or less if the illness is to run its natural course.
Elect to receive hospice care instead of curative treatment for their terminal illness.
Receive care from a Medicare-approved hospice provider.
In which facilities does Medicare pay for hospice?
Medicare pays for hospice care in a variety of settings, including at home, in a skilled nursing facility, in an assisted living facility, in a hospice facility, or in a hospital.
Hospice care at home
Many hospice patients prefer to remain in the comfort of their own homes, surrounded by loved ones. This is the most common setting for hospice care. If you choose to receive care at home, a hospice care provider will visit you at home to provide care, emotional support, and other services.
Hospice care in a skilled nursing facility (SNF)
Hospice care can also be provided in SNFs for patients requiring a higher level of care than they can receive at home. Skilled nursing facilities offer 24-hour nursing care, as well as other services like physical therapy and occupational therapy.
Hospice care in an assisted living facility
If you choose to receive care in your assisted living facility, hospice care providers will stop by to render services, and family or assisted living staff are responsible for care at other times.
Hospice care in a hospice facility
Some hospice providers have their own facilities in which patients can receive care. These facilities are typically designed to provide a comfortable and homelike environment for patients and their families.
Hospice care in a hospital
In some cases, hospice care may be provided in a hospital setting, particularly if the patient requires a high level of medical care for medical issues not tied to their terminal illness.
Does Medicare pay all costs for hospice patients in a skilled nursing facility?
While a skilled nursing facility provides 24-hour care for people who are terminally-ill, it is important to note that Medicare does not cover room and board costs in these facilities.
If hospice care is needed, and the facility is Medicare certified, Medicare will cover all hospice-related services. However, any stay in a skilled nursing facility for hospice care is typically for short-term symptom management or respite care.
Beyond a five-day period for respite care, patients or their families are responsible for room and board costs—unless other programs, such as Medicaid, cover these expenses.
How long does Medicare pay for hospice?
Medicare covers hospice care for as long as a beneficiary needs it, provided they continue to meet the eligibility requirements. Before hospice care begins, two physicians (a patient’s regular physician and a hospice medical director) must determine that a patient is expected to pass away within six months. The patient must also elect to stop receiving medical care for their terminal illness. They may, however, receive care for symptoms not associated with their terminal illness.
Here's how it works:
Initial periods: Medicare provides hospice coverage in benefit periods, starting with a 90-day period. If the patient still needs hospice care after 90 days, they can receive coverage for another 90-day benefit period.
Unlimited extensions: After the initial 180 days (two 90-day periods), Medicare provides coverage in 60-day benefit periods. There is no limit to the number of 60-day benefit periods a beneficiary can receive if they continue to meet the eligibility requirements.
Eligibility requirements: To continue receiving hospice care under Medicare, the beneficiary must be recertified as terminally ill by a physician at the start of each benefit period.
If a person decides to opt out of hospice care or recovers from their illness, they can resume their Original Medicare or Medicare Advantage (Part C) coverage.
Where is the best place to receive hospice care?
Where someone receives hospice care is a personal decision that should be made in consultation with the patient, their family, and their healthcare providers.
What should you consider when choosing a hospice care setting for yourself or a loved one?
The patient's needs: What level of care does the patient require? Can their needs be met at home, or do they need the 24-hour care provided by a specialized care facility?
The patient's preferences: Where does the patient prefer to receive care? Do they want to remain at home or prefer to be in a facility?
The availability of caregivers: Are there family members or friends available to provide care at home? If not, the patient may need to consider a specialized facility.
Cost: The cost of hospice care can vary depending on the setting. Home hospice care is typically the most affordable option, while hospice care in a facility is more expensive.
What other costs is a hospice patient responsible for?
While the Medicare hospice benefit covers services related to terminal illness comfort care, patients are responsible for a few out-of-pocket costs in addition to any applicable room and board.
For any prescription drugs needed for pain relief during hospice care, the patient is responsible for a $5 copayment. Any drugs used to treat unrelated conditions fall under Medicare Part D coverage, with the usual Part D costs applying.
If you have a home caregiver who needs a break, the hospice benefit pays for up to five days of inpatient respite care in a Medicare-certified hospital, skilled nursing facility, or inpatient hospice facility. The patient may have to pay 5% coinsurance for this respite care. Some Medicare Advantage plans might offer more generous benefits for respite care than Original Medicare, potentially reducing out-of-pocket expenses even further.
Though Medicare has limitations on its hospice care, especially for longer-term stays in specialized facilities, it provides significant support to many with terminal illnesses.
What does hospice care include?
For those with a life expectancy of six months or less, Medicare will provide a comprehensive set of services that focuses on giving them what they need to live their last days in peace. Below is a list of what’s covered.
Medical equipment and supplies necessary to manage symptoms and maintain comfort
Skilled nursing care
Drugs and medications for symptom control and pain relief
Social workers and chaplains
Home health care aids
Bereavement support
Short-term inpatient and respite care
Once the transition to hospice and palliative care has been chosen, the Medicare beneficiary forgoes their regular Original Medicare or Medicare Advantage plan treatments aimed at curing their illness. But they retain Medicare coverage for conditions not related to their terminal illness.
Hospice care usually includes nursing visits, symptom management medication, bathing, and grooming but will not cover other services, such as:
Primary care for conditions not related to the terminal illness
Curative treatments
Certain durable medical equipment
Medical transportation for non-hospice needs
Room and board (except during short-term inpatient stays)
Get further advice from Chapter
Have more questions about what Medicare does and doesn’t cover when it comes to hospice care in a skilled nursing facility? Speak with one of our independent Medicare Advisors, who are eager to help you understand your coverage and how to get the most out of Medicare. Get in touch by calling us at (855) 900-2427 or picking a time to chat.