Does Medicare cover hospice care?

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. More than 1.7 million Medicare beneficiaries received hospice care in 2020, with services provided by more than 5,000 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.

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.

How do I qualify for hospice benefits?

To qualify for hospice benefits, a patient must be eligible for Medicare Part A, and a doctor must certify that the patient is terminally ill and has six months or less to live. Medicare-approved programs usually provide care in your home or other facility where you live, such as a nursing home or, in some cases, hospitals.

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). 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, the hospice program will arrange that.

How long will Medicare cover hospice care?

The median length of time in hospice was 21 days in 2020. 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 are typically provided via Original Medicare, even if the beneficiary is enrolled in a Medicare Advantage plan.

Starting in 2021, CMS began piloting a program that allows Medicare Advantage plans to include hospice benefits. As of 2023, there are 15 Medicare Advantage Organizations participating in the hospice pilot program. If a beneficiary is in need of hospice care and is enrolled in a participating Medicare Advantage plan, their hospice care will be provided by the Advantage plan. But most Medicare Advantage enrollees still receive hospice care via Original Medicare.

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).

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 has to notify the Part D plan that the medications are unrelated to the terminal condition. This can be complicated, but it’s important for beneficiaries and their families to understand.

What doesn't Medicare-certified hospice care cover?

Typically, Medicare does not cover room and board in facilities like nursing homes. (Here’s a list of services Medicare won’t cover.) 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.