Hospice care benefits are included with Medicare Part A.
Being a caregiver and having to start hospice care for a loved one can be a difficult and emotional decision. However, your loved one will have a hospice team dedicated to their care, available for 24-hour care. And, most of this care and related services are covered by Medicare, helping to ease the financial burden of end-of-life care.
Read on to learn more about Medicare’s hospice benefit and covered hospice services, as well as information about how to find a hospice care program, how much it will cost, and other things you may need to know about these care services.
Hospice vs. palliative care
The primary objective for both hospice and palliative care is the same, but the prognosis is typically different.
- Hospice care is comfort care without curative intent, meaning the patient no longer has curative options or has chosen to no longer pursue treatment.
- Palliative care is comfort care and may or may not have curative intent.
Palliative care typically happens in a hospital and can happen at any stage of a disease. Hospice care can happen in a person’s home, a hospice facility, or a hospital. It excludes curative treatment, and is typically for patients with a prognosis of six months or less to live.
Medicare covers both hospice and palliative care, depending on the treatment and whether you meet additional requirements.
Medicare hospice benefit
Medicare will cover your hospice care as long as the hospice provider is Medicare-approved.
In order to qualify for hospice care:
- You must have Medicare Part A (hospital insurance)
- Your hospice doctor and regular doctor must certify you’re terminally ill, meaning you have a life expectancy of six months or less
- You accept palliative care to manage pain and symptoms rather than treatment intended to cure your condition
- You sign a statement saying you’re foregoing medical treatment for your illness and instead choose hospice
This care can be given in a patient’s home, a facility like a nursing home, or an inpatient hospice facility.
You and your family will work with your hospice team to develop a plan of care that will support the level of care you need. Your hospice care team may include:
- Doctors (including a hospice doctor and your regular doctor)
- Family members
- Home health aides
- Hospice aides
- Nurses or nurse practitioners
- Occupational therapists
- Physical therapists
- Social workers
Once your hospice benefit begins, Original Medicare will cover everything you need related to your terminal illness. A hospice nurse and doctor are on-call 24 hours a day, seven days a week, so hospice patients can get the care and support they need at any time. Services you may need include:
- Dietary counseling
- Doctor, nursing, or medical services
- Durable medical equipment (DME)
- Inpatient respite care
- Medical supplies
- Other services required to manage your pain and symptoms
- Pain management medications
- Physical or occupational therapy services
- Short-term inpatient care for pain or symptom management (though it must be in a Medicare-approved facility)
- Social services
- Spiritual or grief counseling
Medicare will also pay for services not related to your terminal illness, but you must pay the deductible and any co-pay or co-insurance amounts for these services.
Do Medicare Advantage plans cover hospice care?
Medicare Part C, more commonly known as Medicare Advantage (MA), combines your Medicare Parts A and B benefits in a single plan, similar to health insurance you may have had through an employer.
Although most MA plans provider more benefits that you get with Original Medicare, hospice care is usually still provided through Part A. However, some Medicare Advantage plans do include hospice, so review your Summary of Benefits for information specific to your plan.
You should also talk to your plan provider to find a hospice provider in your area that is Medicare-approved. Keep in mind that you must continue to pay your plan’s premiums to remain in the MA plan.
If you remain in your MA plan, you can choose to get services not related to your illness from providers in your plan’s network or other Medicare providers, especially because MA plans can still cover these services. The amount you pay out-of-pocket depends on your plan, whether you see in-network providers, and the type of services you receive.
Note that if you choose to leave hospice care, your MA plan won’t start again until the first of the following month.
How much does hospice care cost?
Hospice care doesn’t cost anything. However, you’ll pay a $5 co-pay for each prescription for outpatient drugs for pain and symptom management. If your hospice benefit doesn’t cover the drug, contact your Part D plan to learn what is and isn’t covered and what you’ll pay for them.
You’ll also pay 5% of the Medicare-approved amount for inpatient respite care.
If you live in a facility and choose to get hospice care, you must still pay for room and board.
Where to get hospice care
Unless you need an in-patient facility, you’re able to stay with your family in your own home. If it is determined that you need in-patient care, your hospice care team will make all of the arrangements for you. The cost of in-patient care is covered by Part A, though it’s paid to your hospice provider.
If you go to the hospital and your hospice care team didn’t make the arrangements, you’re responsible for 100% of the cost.
You can also choose to change your hospice provider once during each benefit period.
How long can you get hospice care?
Hospice care is typically for people who have a life expectancy of six months or less. Medicare covers hospice for two, 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
Even if you live longer than six months you can still get hospice care, but the hospice medical director or a doctor must recertify that you’re terminally ill. They must also certify you’re terminally ill at the start of the first 90-day benefit period, and at the start of each benefit period after the first 90-day period. This will help ensure you can continue to get hospice care.
Can you stop hospice care?
If your health improves, your illness goes into remission, or you decide you no longer want hospice care, you can choose to stop your care. This can happen at any time, and you’ll be asked to sign a form that includes the date your care will end.
If you were in an MA plan when you started hospice, you can continue to stay in that plan as long as you pay the premiums. If you were on Original Medicare, that will continue.
Keep in mind that if you become eligible again at any time, you can go back to hospice care.
How to find a hospice program
Hospice doctors, nurses, and other care team members will be an important part of your life for as long as you need them. That’s why it’s so important to choose a hospice program you are comfortable with. Additionally, not everyone’s hospice wants and needs are the same, so there are factors to take into consideration and questions to ask before choosing such as:
- Can I get care at home? Does the provider train caregivers to help me at my home?
- How does my regular doctor work with the hospice doctor?
- How do you ensure quality care?
- Do you have hospice volunteers? What services do they provide?
- How often does the hospice staff meet with each other, and how often will they meet with my family to discuss needs and care?
- How does staff respond to after-hour emergencies or needs?
To find and compare Medicare-certified hospices that services your area, visit Medicare.gov to use their Find a Provider search tool.
What is not covered by Medicare?
There are a few things not covered by Medicare once your hospice benefit starts, including:
- Treatment intended to cure your terminal illness and/or related conditions
- Prescription drugs to cure your illness
- Care from any hospice provider that wasn’t set up by the hospice medical team
- Room and board
- Care you get as a hospital outpatient or inpatient (unless it’s arranged by your hospice care team or is unrelated to your terminal illness)
- Ambulance transportation (unless it’s arranged by your hospice care team or is unrelated to your terminal illness)
If you aren’t sure whether something is covered, talk to your hospice care team prior to receiving any services or treatment. Otherwise, you may have to pay the cost 100% out-of-pocket.
Does Medicare cover nursing homes?
Medicare does not cover custodial care, which is non-skilled personal care that helps you with activities of daily living like:
- Using the bathroom
- Getting in and out of bed or a chair
- Other personal needs that can be done safely or reasonable without professional skills or training
However, Medicare Part A may cover care in a certified skilled nursing facility (SNF) if it is medically necessary for you to have skilled nursing care. This type of care can only be done by a registered nurse or doctor.
Some Medicare Advantage plans may offer additional nursing home care benefits, so check with your plan for more information.
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