Does Medicare cover hospice care?
Medicare covers almost all aspects of hospice care with little expense to patients or families, as long as a Medicare-approved hospice program is used. About 1.7 million Medicare beneficiaries receive hospice care annually, with services provided by nearly 6,000 hospice programs nationwide.
Hospice programs provide care and support for people who are terminally ill. Their focus is on comfort, or “palliative” care, not on curing an illness.
What is hospice care?
Hospice care provides comfort and support for terminally ill patients and their families. It does not attempt to cure the patient’s illness. Instead, hospice care focuses on providing comfort, pain relief, and management of symptoms.
Does Medicare cover palliative care?
Yes, Medicare will cover palliative care, although the specifics depend on whether it’s in conjunction with hospice care. Palliative care is designed to make the patient comfortable, but it can be provided alongside curative care or hospice care.
If the patient has opted for hospice care, palliative care is covered with little or no out-of-pocket costs, as described in more detail below. But if a patient is still receiving treatment for their medical condition (ie, still working toward a cure, as opposed to hospice care), Medicare’s regular cost-sharing can apply to medically necessary palliative care. This can include deductibles, coinsurance, and copays for Original Medicare, Medicare Advantage, and Medicare Part D.
Hospice care
Palliative care
Is patient terminally ill?
Can the patient still receive curative treatment?
What is the focus of the care?
Providing comfort and symptom relief instead of curative treatment
Providing comfort and symptom relief, either instead of or in addition to curative treatment
Does Medicare cover it?
Yes, Medicare Part A covers hospice care for a patient whose doctor certifies that they are terminally ill, and who opts for hospice care instead of curative care
Yes, as part of hospice care. In conjunction with curative care, palliative care can be covered if it's considered medically necessary
What is the patient's life expectancy?
Six months or less, for Medicare coverage
Palliative care can be provided at any stage of a patient's disease
Where is the care provided?
Usually at home or a facility where the person lives
Often in a hospital or the facility where the patient is being treated for their disease
How do I qualify for hospice benefits?
To qualify for hospice benefits, a patient must have Medicare Part A (either via Original Medicare or Medicare Advantage; details about this are below), and a doctor must certify that the patient is terminally ill and has six months or less to live. Medicare-approved hospice programs usually provide care in your home or other facility where you live, such as a nursing home. In rare cases, Medicare-covered hospice care can be provided in an inpatient hospital setting.
To qualify for Medicare hospice care, does it matter where I receive the care?
In most cases, hospice care is provided in the beneficiary’s home or the facility where they live (such as a nursing home; note that nursing home room and board costs are not covered by Medicare, regardless of whether the person is enrolled in hospice or not). The hospice care must be provided by a Medicare-approved hospice program, and Medicare has an online tool that beneficiaries can use to find and compare hospice programs. If inpatient care or respite care is needed (to give the person’s normal caregiver a break), the hospice program will arrange that.
How long will Medicare cover hospice care?
The median length of time in hospice was 18 days in 2022. But there’s wide variation from one patient to another, and there is no limit on how long Medicare will cover hospice care. To receive hospice care, your hospice doctor (and your primary doctor if you have one) has to certify that you’re terminally ill and have a life expectancy of no more than six months. Initially, your coverage is for a 90-day benefit period. Another 90-day benefit period starts after that, as long as the doctor still certifies that you are expected to live no more than six months. The coverage can then be extended in six-month increments, with the same certification necessary at the start of each benefit period. Hospice coverage will end if your doctor certifies that you’re no longer terminally ill, or if you decide you no longer want hospice care.
Does Medicare Advantage include coverage of hospice care?
When a Medicare beneficiary enters hospice, the hospice benefits will be provided via Original Medicare, even if the beneficiary is enrolled in a Medicare Advantage plan.
Starting in 2021, CMS began piloting a program that allowed Medicare Advantage plans to include hospice benefits. But the pilot program ended at the end of 2024. So it is once again the case that all Medicare beneficiaries who need hospice care receive that coverage under Original Medicare, regardless of whether they have Original Medicare or Medicare Advantage.
If a Medicare Advantage enrollee who is in hospice care (provided under Original Medicare) needs treatment for something that isn’t part of the terminal illness or related conditions, they can choose to use Original Medicare or their Medicare Advantage coverage (assuming they have opted to continue their Medicare Advantage coverage, including paying monthly premiums if the plan has them). So for example, if a patient is in hospice for terminal cancer (and thus no longer receiving curative treatment for the cancer) but they fall and break their leg, they can receive treatment for the broken leg, and this will be under their Medicare Advantage plan if they’ve opted to keep that coverage.
What does Medicare hospice coverage include?
Medicare hospice coverage includes a full complement of medical and support services for a life-limiting illness, including drugs for pain relief and symptom management; medical, nursing, and social services; certain durable medical equipment, and other related services, including spiritual and grief counseling, which Medicare typically doesn’t cover. Medicare does not cover room and board costs for inpatient hospice care, but the program will cover occasional respite care, which is a short-term stay at a qualified hospice facility. Respite care gives the usual caregiver a chance to rest, and can last up to five days at a time.
Will I have to pay anything for Medicare hospice care?
There’s no deductible for hospice care, and copays for covered medications for pain or symptom management won’t exceed $5. If inpatient respite care is needed, the patient will pay 5% of the Medicare-approved amount.
If a hospice patient needs medications that aren’t related to the terminal condition, their Part D plan would still have to cover them with its normal cost-sharing requirements, and their medical provider should notify the Part D plan that the medications are unrelated to the terminal condition.
What doesn't Medicare-certified hospice care cover?
Typically, Medicare does not cover room and board in facilities like nursing homes. But in-patient hospice care is covered during respite care, or at other times if the hospice program deems it necessary and arranges it. If a hospice patient receives respite care, the patient will be billed 5% of the Medicare-approved cost of the inpatient care, and Medicare will pay the other 95%. Medigap plans can help to cover the out-of-pocket costs associated with hospice care, including respite care.
