The term hospice refers to treatment, services, and care for people who have an illness and are not expected to live longer than 6 months.
Making decisions about hospice care, whether for yourself or someone you love, is not easy. Getting direct answers about what hospice costs and how you can pay for it may make a difficult decision a little clearer.
Original Medicare (Medicare Part A and Part B) does pay for hospice care, as long as your hospice provider is enrolled in the program and accepts Medicare coverage. A Medicare Advantage (Part C) plan will also cover hospice care.
If youâ€™re looking for specific answers about which hospice facilities, providers, and services are covered under Medicare, this article will help you answer those questions.
When does Medicare cover hospice?
Medicare covers hospice once a medical doctor certifies that you have an illness that makes it unlikely you will live longer than 6 months.
To get this coverage, you must sign a statement that confirms:
- you want palliative care
- you donâ€™t intend to continue seeking treatments to cure the illness
- you choose hospice care instead of other Medicare-approved services to treat your illness
If you (or a loved one) are receiving hospice care, that means your doctor has certified that your life expectancy is 6 months or less. However, some people defy expectations.
At the end of 6 months, Medicare will keep paying for hospice care if you need it. The hospice medical director or your doctor will need to meet with you in person and re-certify that your life expectancy is still not longer than 6 months.
Medicare will pay for two 90-day benefit periods. After that, you can re-certify for an unlimited number of 60-day benefit periods. During any benefit period, if you want to change your hospice provider, you have the right to do so.
Which parts of Medicare cover hospice care?
There are many different parts Medicare. Each part provides coverage for different items and services. Here is a breakdown of the role each part of Medicare may play in covering your hospice care:
- Medicare Part A. Part A pays for hospital costs, should you need to be admitted to care facility for your symptoms or to give your caregivers a short break.
- Medicare Part B. Part B covers outpatient medical and nursing services, medical equipment, and other treatment services.
- Medicare Part C. If you have a Medicare Advantage plan, it will remain in effect as long as youâ€™re paying premiums, but you wonâ€™t need them for your hospice expenses. Original Medicare pays for those. Your Medicare Part C plans can still be used to pay for treatments that are not related to the terminal illness or arenâ€™t covered by original Medicare.
- Medicare supplement (Medigap). Medigap plans can help with costs unrelated to the terminal illness. You wonâ€™t need these benefits to help cover hospice expenses, since those are paid for by original Medicare.
- Medicare Part D. Your Part D prescription drug coverage will still be in effect to help you pay for medications that are unrelated to the terminal illness. Otherwise, medications to help treat symptoms or manage the pain of a terminal illness are covered through your original Medicare hospice benefit.
What is covered by Medicare?
Original Medicare pays for a wide range of services, supplies, and prescriptions related to the illness that caused you to seek hospice care, including
- doctor and nursing services
- physical, occupational, and speech therapy services
- medical equipment, like walkers and hospital beds
- nutrition counseling
- prescription medications you need to relieve symptoms or control pain
- short-term inpatient care to help you manage pain or symptoms
- social work services and grief counseling for both patient and family
- short term respite care (up to 5 days at a time) to allow your caregiver to rest, if you are being taken care of at home
If you are receiving hospice benefits, Medicare Part A will still pay for other nonterminal illnesses and conditions you may have. You can also keep your Medicare Advantage plan while youâ€™re receiving hospice benefits in case there is additional coverage youâ€™d like to continue using.
To find a hospice care provider in your area, try this agency finder from Medicare.
How much does hospice care cost with Medicare?
How much hospice care costs depends on the type of illness and how early patients enter hospice. In 2018, the Society of Actuaries estimated that hospice patients with cancer received Medicare Part A and Part B benefits totaling around $44,030 during the last 6 months of their lives.
That figure includes the cost of inpatient hospital treatments, in addition to at-home hospice care.
The good news is that there are no deductibles for hospice care under Medicare.
Some prescriptions and services may have copays. Prescriptions for pain medications or symptom relief may carry a $5 copay. There may be a 5 percent copay for inpatient respite care if you are admitted to an approved facility, so your caregivers can rest.
Other than those instances, you wonâ€™t have to pay for your hospice care.
What is not covered by Medicare?
While Medicare covers most items and services youâ€™ll need during hospice, there are a few things it wonâ€™t cover, such as:
- Any treatments to cure the terminal illness. This includes both treatments and prescription medications that are intended to cure you. If you decide you want treatments to cure your illness, you can stop hospice care and pursue those treatments.
- Services from a hospice provider that were not arranged by your hospice care team. Any care you receive has to be provided by the hospice provider that you and your team chose. Even if you are receiving the same services, Medicare will not cover the cost if the provider isnâ€™t the one you and your hospice team named. You can still visit your regular doctor or another healthcare professional if you selected them to supervise your hospice care.
- Room and board expenses. If you are receiving hospice care at home, in a nursing home, or in an inpatient hospice facility, Medicare wonâ€™t cover the cost of room and board.
- Care at an outpatient hospital facility. Medicare wonâ€™t pay for ambulance transportation to the hospital or for any services you receive in an outpatient hospital setting, such as the emergency room, unless it is not related to your terminal illness or unless it has been arranged by your hospice team.
The bottom line
If you have original Medicare coverage and are considering hospice care, the Medicare hospice benefit will pay for the care you need.
You will need a doctor to certify that your life expectancy is not longer than 6 months, and you will need to sign a statement accepting hospice care and stopping treatments aimed at curing the illness. If you have met those requirements, your doctor and nursing care, prescriptions, and a range of other support services will be covered.
One important exception to note: Original Medicare does not pay for room and board for hospice patients, so long-term residence in a nursing home or skilled nursing facility wonâ€™t be covered as part of a hospice benefit.
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