Does Medicare Cover Hospice Care?

The answer is yes, Medicare covers hospice, but you must qualify and use a Medicare-approved hospice provider.
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Hospice is a type of care in which a team of specialized health care professionals make someone who is terminally ill as comfortable as possible during the time they have remaining.

Medicare covers hospice care, but you must meet specific requirements

Centers for Medicare & Medicaid Services. Hospice Care. Accessed Feb 20, 2023.
:

  • You must be enrolled in Medicare Part A.

  • The hospice provider must be Medicare-approved.

  • You must be certified terminally ill by a hospice doctor and your doctor (if you have one), meaning you’re expected to live six months or less.

  • The hospice care must be for comfort care, not because you’re trying to cure your condition.

  • You must sign a statement opting for hospice care over other Medicare benefits to treat your illness. (See an example of this statement here.

    Centers for Medicare & Medicaid Services. Hospice. Accessed Feb 20, 2023.
    ) If you’re thinking about seeking treatment to cure your illness, talk to your doctor — you can stop hospice care at any point.

Hospice care through Medicare generally takes place in your home or a facility where you live, such as a nursing home.

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What hospice care is covered by Medicare?

Hospice care providers care for the “whole person,” meaning they help address spiritual, emotional, social and physical needs

Centers for Medicare & Medicaid Services. Medicare Hospice Benefits. Accessed Feb 20, 2023.
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The following things related to hospice care are covered, according to Medicare:

  • All items and services needed for pain relief and symptom management.

  • Medical, nursing and social services.

  • Drugs to manage pain.

  • Durable medical equipment for pain relief and managing symptoms.

  • Aide and homemaker services.

  • Other covered services needed to manage pain and additional symptoms, and spiritual and grief counseling for you and family members.

In addition to you and your family members, your hospice care team may include some or all of the following:

Doctors

Physical and occupational therapists

Nurses or nurse practitioners

Speech-language pathologists

Counselors

Hospice aides

Social workers

Homemakers

Pharmacists

Volunteers

You’ll also have the option of a hospice nurse and doctor who are on-call 24/7, for the sole purpose of giving your family support.

How much does hospice cost on Medicare?

Under Original Medicare, there are no costs for hospice care, although you’ll still pay any Medicare Part A and Medicare Part B premiums.

You’ll pay a copayment of up to $5 for each prescription for outpatient drugs to manage pain and symptoms. You may also pay 5% of the Medicare-approved amount for inpatient respite care — this is care you get in a Medicare-approved facility so your day-to-day caregiver can rest. Respite care allows the hospice patient to have a short-term stay of up to five consecutive days at a time as an inpatient, and it may be done on an occasional basis.

What hospice services aren't covered by Medicare?

Once your hospice benefit has begun, Medicare will not cover any of the following:

  • Curative treatment. Any treatment meant to cure your terminal illness or any related conditions.

  • Curative drugs. Prescription drugs meant to cure your condition.

  • Care from a hospice provider that wasn’t arranged by your hospice medical team. Once you've named your hospice provider, you must get care arranged by them. You can still see your primary doctor or nurse practitioner if you’ve picked them to be the attending medical professional that helps manage your care.

  • Room and board. If you’re at home or you live in a nursing home or hospice inpatient facility, Medicare will not cover room and board. If your hospice team decides you need a short inpatient or respite care stay, Medicare will cover the costs, although you may owe a small copayment.

  • Care received as a hospital outpatient (such as in an ER), as a hospital inpatient or ambulance transport. However, Medicare will cover these services if they’re arranged by your hospice team or they’re not related to your terminal illness.

If you have other health issues that aren’t related to your terminal illness, Medicare will continue to pay for covered benefits, but generally, hospice focuses on comfort care.

Starting Medicare hospice care

If you have Original Medicare, you must find a hospice provider that is Medicare-approved. (You can do that here, as well as asking your doctor, your state hospice organization or state health department.)

If you have Medicare Advantage, your plan can help you find a local hospice provider.

The hospice benefit is meant to allow you and your family to stay together at home unless you require care at an inpatient facility. If you need inpatient care at a hospital, the arrangements must be made by your hospice provider — otherwise you might be responsible for the costs of your hospital stay

Centers for Medicare & Medicaid Services. How hospice works. Accessed Feb 20, 2023.
.

How long can you get Medicare hospice care?

Generally, people who have been diagnosed with a terminal illness that is expected to end their life within six months consider hospice. However, if you’ve been in hospice for six months, you can continue to receive hospice care, provided the hospice medical director or hospice doctor reconfirms your terminal illness at a face-to-face meeting.

Under your hospice benefit, you’re covered for hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. At the start of every benefit period after the first, you must be recertified as terminally ill.

What if you’re in a Medicare Advantage plan?

Once your hospice benefit begins, everything you need will be covered by Original Medicare, even if you decide to stay in your Medicare Advantage plan or another Medicare health plan. (You do have to continue paying your Medicare Part B premium and any premiums required by the Medicare Advantage plan.)

If you remain a member of a Medicare Advantage plan, you can use the plan’s network for services that aren’t related to your terminal illness, or you can use other Medicare providers. Your costs will depend on the plan and how you follow the plan’s rules.

Medicare Advantage companies

Get more information below about some of the major Medicare Advantage companies. These insurance companies offer plans in most states. The plans you can choose from will depend on your ZIP code and county.

🤓Nerdy Tip

Drugs for helping with your terminal illness are covered under hospice payments. But you may still need additional prescriptions to manage other health conditions. If you start hospice care after Oct. 1, 2020, you can request a list of items, services and drugs from your hospice provider that they’ve classified as unrelated to your terminal illness and related conditions, including the reasons behind their inclusion on the list. (Find an example of this kind of statement here.) In those cases, your Part D or Medicare Advantage plan would cover those costs, so maintaining those policies is important.

Can you stop Medicare hospice care?

If your condition gets better or goes into remission, you may wish to end hospice care. You can stop hospice care at any point, but you must make it official: You’ll need to sign a form that states the date your care will stop.

Note that you should sign a form of this kind only if you are ending hospice — there are no forms with an end date when you start hospice care.

If you were in a Medicare Advantage plan, you’ll still be a member of that plan after you end hospice and are eligible for coverage from the plan. If you’re a member of Original Medicare, you can continue with Medicare after you end hospice care.

If you have additional questions about your Medicare coverage, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY: 877-486-2048).

Shopping for Medicare plans? We have you covered.

MEDICARE SUPPLEMENT, or Medigap, is private health insurance that covers “gaps” in traditional Medicare coverage. Compare options from our Medigap roundup.

Best for Medigap plan options

Best for premium discounts

MEDICARE PART D covers outpatient prescription drugs for people on Medicare. Compare options from our Medicare Part D roundup.

Best for member satisfaction

Best for low premiums

MEDICARE ADVANTAGE is an alternative to traditional Medicare offered by private health insurers. Compare options from our Medicare Advantage roundup.

Best for size of network

Best for low-cost plans

Star ratings from CMS and on a 5-★ scale.

Frequently asked questions

No, once you go on hospice care, everything related to your terminal illness is covered by Original Medicare, even if you have a Medicare Advantage plan or another Medicare health plan.

Hospice care is not intended to provide any services meant to cure your terminal illness and any related conditions. So your hospice benefit won’t cover any curative treatments, prescription drugs for unrelated conditions, care from other providers who aren’t on your hospice team, room and board not related to inpatient needs or respite care, and any care as a hospital outpatient — unless your hospice team sets it up or its related to another condition.

Medicare Part A covers all service costs for hospice care, so there is no deductible. The only costs to you are any premiums you pay for Medicare Part A and Part B, copayments of up to $5 per prescription and 5% of Medicare-approved costs for inpatient respite care.

The four levels of Medicare hospice care are as follows:

  • Routine home care: This is the most common level, and it’s typically provided at home. This is provided when the patient is stable and symptoms are under control.

  • General inpatient care: This is a crisis level of care, intended to provide short-term services to a patient whose symptoms are out of control. This is typically provided outside the home.

  • Continuous home care: This is a crisis level of care, intended to provide short-term services to a patient whose symptoms are out of control, but typically provided in the home.

  • Respite care: This is temporary care provided in a facility like a nursing home or hospice inpatient facility, to give the caregiver a rest from caregiving.

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