Does Medicare Pay for Hospice Care?

For people in need of hospice care at the end of life, thinking about how to pay for it is probably not at the top of your list. Even if you’re simply thinking ahead, you may be wondering if Medicare will cover hospice services.

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The short answer is yes. Medicare does indeed cover hospice care, and in fact, original Medicare beneficiaries pay nothing for most hospice care services. However, in order to receive Medicare, patients need to meet specific eligibility criteria. Being aware of these criteria can better prepare you in the event you need hospice care.  

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Who Is Eligible For Medicare Hospice Services?

If you’re a Medicare beneficiary with Medicare Part A (also called hospital insurance), you only qualify for hospice care if you meet the following conditions::  

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• Your regular doctor and hospice doctor certify that you are terminally ill with a 6-month-or-less life expectancy
• You choose to receive symptom management and forego curative treatment
• You elect—by signing a statement—to receive hospice care instead of other covered treatments for your terminal illness
• You use a Medicare-certified hospice provider

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What Hospice Services Does Medicare Fully Cover?

Simply put, Medicare can fully cover your hospice care services. As long as your hospice care team certifies that you need them, you will owe nothing for the following hospice care services:

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• Doctors’ appointments and care
• Nursing
• Durable medical equipment used for symptom management and pain relief
• Medical supplies
• Home health aide
• Physical therapy, occupational therapy, and speech-language pathology services
• Social worker support
• Dietary counseling
• Grief counseling for you and your family members
• Short-term inpatient pain and symptom management care in an approved Medicare facility
• Infrequent inpatient respite care stays of up to five days in a Medicare-approved facility

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There may be some other services that can be covered under Medicare, as long as they are related to symptom management and not curative treatment. If you or your loved one are unsure whether a possible symptom fits under non-curative treatment, consult your hospice nurse or doctor.

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Do I Owe Any Hospice Coinsurance With Medicare?

Not everything is completely paid for by Medicare. For example, hospice providers may charge you directly for a few hospice-related costs, such as prescription drugs and some respite care services. These are some of the costs that may not be covered:

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• Copayment of up to $5 per prescription for any outpatient prescription drugs you need for managing pain and symptoms
• 5 percent of the Medicare-approved amount for inpatient respite care services you need, including room and board costs  

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While on hospice, you will also need to continue paying your Medicare A and B premiums to maintain your insurance coverage.

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What Services Are Not Covered By Medicare During Hospice Care?

Many services are typically covered by Medicare, which includes supplies and additional prescriptions as mentioned above. But there are a few things outside of medications that are not covered by Medicare. These are typically specific circumstances or additional support structures outside of traditional hospice care. Let’s take a look at what Medicare does not cover.

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Room and Board

Medicare Part A will not cover room and board costs while you’re receiving hospice care. It doesn’t matter if you’re in your own home, a nursing home, a hospice facility, or another long-term care facility. The only exceptions are infrequent short-term care in a facility or respite care services.

Any Care That Your Hospice Team Didn’t Set Arrange

The hospice care provider and your hospice team are in charge of your hospice care, so all planned procedures and emergency treatments go through your team. If you designate your regular doctor or nurse practitioner to oversee your hospice care, you can continue to see them for medical care.

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Curative Drugs or Treatment

As part of the criteria for receiving hospice care, you will no longer receive any curative drugs or treatment for your terminal illness. That’s pretty much the main requirement you need to fulfill in order to obtain hospice care. But hospice care does not mean suffering in the least. Medicare will keep covering pain or symptom management drugs. If you wish to begin curative treatment , you can stop hospice care at any time.

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Hospital Care and Ambulance Rides

Medicare will not cover ambulance rides, inpatient care, or outpatient hospital care unless it’s scheduled by your hospice care team. Though it will cover these types of services if it is for a condition unrelated to your terminal illness.

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How Long Can You Be On Hospice With Medicare?

When your hospice doctor and your regular doctor certify that you have six months or less to live, it’s just a rough estimate based on the progression of your illness. In reality, you can receive Medicare-covered hospice care services for as long as you meet the eligibility requirements—even if that’s well beyond six months.

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Traditionally, Medicare uses benefits periods when approving hospice care coverage. This means that you can receive hospice care for two 90-day benefit periods, or six months. After these six months, Medicare will cover an unlimited number of 60-day benefit periods. Your hospice doctor and your regular doctor must recertify that you qualify at the beginning of each benefit period.

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How Much Does Medicare Pay For Hospice Care?

There is an actual cost breakdown that Medicare pays to hospice providers at a fixed daily rate. Regardless of how many services you actually receive on a given day, the daily payment rates are as follows for 2022:

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The Bottom Line on Medicare Hospice Care Coverage

Any aging adults or other folks who want to receive hospice care can do so without fear of paying exorbitant amounts. Medicare can help cover the basics, giving families and loved ones a bit of breathing room. In fact, some older adults who receive hospice care pay nothing out of pocket. During a time when life feels uncertain, knowing that your end-of-life care is covered means there’s one less thing to worry about.

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What if you or your loved one have a Medicare Advantage plan? Let us guide you to find the best payment options for hospice services.

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References

1. “Hospice Care.” Medicare.gov, www.medicare.gov/coverage/hospice-care.
2. “Hospice.” Centers for Medicare & Medicaid Services (CMS), 14 March 2022, www.cms.gov/medicare/medicare-fee-for-service-payment/hospice.  
3. “Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2022.” Centers for Medicare & Medicaid Services (CMS), 4 August 2021, www.cms.gov/files/document/r10929CP.pdf#page=7.