Yes. Medicare Part A covers hospice care for patients who meet Medicare’s eligibility rules and choose the hospice benefit. Families generally pay nothing for hospice care from a Medicare-approved hospice, with small possible costs for some prescriptions and respite care. Coverage for each patient should be confirmed with the hospice or Medicare. The Medicare hospice benefit resource gives the fuller overview.
What does the Medicare hospice benefit include?
The benefit covers services related to the terminal illness under an individualized plan of care. Depending on need, services may include nursing visits, physician involvement, hospice aide and homemaker support, social work, spiritual care, counseling, medical equipment, supplies, medications related to the terminal illness and short-term inpatient or respite care. See Medicare.gov’s hospice coverage guidance for current federal information.
Hospice care may be provided in a private home, an assisted living residence, a skilled nursing facility or another approved setting. The hospice explains which services it provides directly and how it coordinates with other clinicians.
Who qualifies for Medicare hospice coverage?
A patient qualifies when they have Medicare Part A, a physician certifies a life expectancy of six months or less if the illness follows its expected course and the patient chooses hospice instead of treatment meant to cure the terminal illness. The hospice physician and the attending physician, when there is one, take part in certification. Each decision is individual and is never made from an article alone.
What does signing the election statement mean?
Electing hospice means choosing comfort-focused care and waiving Medicare payment for treatment meant to cure the terminal illness and related conditions. It does not waive Medicare payment for unrelated medical care. A patient can ask questions before signing and can discuss changing goals with the team at any time. Reading the election statement as a conversation explains each part.
How long will Medicare pay for hospice?
Medicare covers hospice for as long as the patient remains eligible. The benefit includes two 90-day benefit periods followed by an unlimited number of 60-day periods. The hospice physician recertifies eligibility at the start of each period.
What will a family pay out of pocket?
For most families the hospice benefit itself is covered in full with no deductible. Patients continue to pay their usual Medicare Part A and Part B premiums. Medicare allows up to a $5 copayment for each outpatient prescription for pain and symptom management and 5% of the Medicare-approved amount for inpatient respite care. Respite care is a short inpatient stay of up to five days in a row that gives the family caregiver a rest.
Coverage can vary with the services and plans involved. Ask the hospice to identify any possible costs before care begins.
Does Medicare Advantage change hospice coverage?
Original Medicare pays for hospice care, even when the patient stays enrolled in a Medicare Advantage plan. The Medicare Advantage plan may continue to cover eligible care unrelated to the terminal illness and related conditions. Ask the hospice how the plans coordinate.
Does Medicare cover 24-hour care at home?
No. Hospice provides scheduled visits and 24/7 nurse access by phone according to the plan of care. It does not provide a nurse at the bedside around the clock, except during short periods of Continuous Home Care when Medicare criteria are met. Family caregivers and other supports remain part of the plan.
What if the patient also has Medi-Cal, VA benefits or private insurance?
Bring plan names and member numbers to the first conversation. The hospice billing or admissions team explains how the benefits coordinate. Supplies and equipment unrelated to the terminal illness may fall under another benefit or provider.
Can a patient stop hospice and return to regular Medicare?
Yes. A patient may revoke the hospice benefit at any time and return to standard Medicare coverage for the illness. The patient can elect hospice again later if still eligible. The hospice explains the process and any implications.
Questions to ask the hospice about coverage
- What supports the patient’s eligibility?
- Which services and medications are related to the terminal illness?
- What equipment can be arranged?
- How does respite care work?
- Who handles our coverage questions?
- What happens if goals change or the patient leaves hospice?
Ask for written information and a contact for follow-up. The Family Guide helps organize questions. The referral page explains next steps.