The purpose of hospice is to preserve the quality of life for those who have a limited time to live. Hospice workers address the physical, emotional and spiritual needs of a terminally ill person who is expected to live six months or less. If your loved one is eligible for Medicare, his or her hospice care might be covered.
Requirements for Medicare to Cover Hospice
- Your loved one must be eligible for Medicare Part A (Hospital Insurance).
- A doctor and the hospice medical director must certify that your loved one is terminally ill and has 6 months or less to live.
- Your loved one (or his/her legal guardian) must sign a statement choosing hospice care instead of other Medicare-covered benefits to treat the terminal illness.
- Care must be provided by a Medicare-approved hospice provider.
What Hospice Services Does Medicare Cover?
- Doctor services
- Nursing care
- Durable medical equipment (such as wheelchairs or walkers)
- Medical supplies (such as bandages and catheters)
- Drugs for symptom control or pain relief
- Nutritional/dietary counseling
- Hospice aide and homemaker services
- Physical and occupational therapy
- Social worker services
- Grief and loss counseling for the family
- Short-term inpatient care (for pain and symptom management)
- Short-term respite care
Respite Care Helps Caregivers
A terminally ill person can get inpatient respite care from a hospice if the patient's usual caregiver needs a rest. During this time, your loved one will be cared for in a Medicare-approved facility, such as a hospice inpatient facility (hospice home), hospital, or nursing home. There may be a copayment required for the time the person spends in the in-patient facility.
What Medicare Will Not Cover
- Treatment intended to cure the terminal illness
If your loved one decides to receive curative treatment for their terminal illness, then hospice care is not covered. Hospice patients have the right to stop hospice care at any time.
- Prescription drugs to cure the illness, rather than manage symptoms
Only drugs intended for pain relief and symptom control are covered by Medicare's Hospice program.
- Care from any hospice provider that wasn't arranged by the hospice medical team
ALL care must be given by or arranged by the hospice medical team. Your loved one can't get the same type of hospice care from a different provider, unless you officially change the selected Medicare-approved hospice provider.
- Room and board
Medicare doesn't cover room and board for hospice care. It does not cover the cost of rent or fees for a home, nursing home or assisted living. However, if the hospice medical team determines that your loved one needs short-term inpatient or respite care services that they arrange, then the stay in the nursing home or assisted living facility is covered. If your loved one's permanent home was already in the nursing home, hospice care is covered.
- Emergency care
Care in an emergency room, inpatient facility care, or ambulance transportation is not covered unless it is arranged by the hospice medical team or unrelated to the terminal illness.
What You Pay for Hospice Care
Medicare pays the hospice provider for your loved one's care. The following will typically be paid for privately, but ask questions of the hospice you have chosen because their rules may vary.
Your loved one will pay no more than $5 for each prescription drug and other similar products for pain relief and symptom control.
5% of the Medicare-approved amount for inpatient respite care
For example, if Medicare pays $100 per day for inpatient respite care, your loved one will pay $5 per day. He or she can stay in a Medicare-approved hospital or nursing home up to 5 days each time he/she gets respite care.
How Long Can You Receive Hospice Care?
The hospice benefit includes two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. Terminally ill people can get hospice care as long as the doctor and the hospice medical director continues to certify that your loved is terminally ill and has 6 months or less to live if the disease runs its normal course. If the patient lives longer than 6 months, he or she can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies the terminal illness.
Medicare recipients who reach their third hospice benefit period must have a face-to-face meeting with a hospice doctor or nurse practitioner. The third benefit period begins on day 180 of hospice. After that, your loved one must continue to have face-to-face meetings with a hospice doctor or nurse practitioner before the start of each following 60-day benefit period. The meeting must take place no earlier than 30 days before the new benefit period to confirm they still qualify for hospice care.