Medicare is a federal health insurance coverage program for American adults that are at least 65 years old. You may know that Medicare covers home health care under certain circumstances, but does Medicare cover hospice care too?
Does Medicare cover hospice?
In short, yes, Medicare covers hospice services. However, full coverage is only available if you meet the qualifying circumstances and choose your care from a Medicare-certified agency, meaning they operate under quality standards set by the U.S. government.
The Medicare hospice benefit covers the cost of care for you or your loved one’s terminal illness and related conditions. It covers hospice care for two 90-day and unlimited 60-day periods, if no revocations (choosing to change your mind about hospice) or discharges occur. There is no copay or out-of-pocket cost for qualified Medicare beneficiaries.
Learn more about the conditions one must meet to be eligible for hospice coverage below.
How do I qualify for hospice coverage under Medicare?
Medicare will cover hospice care services if you have Medicare Part A (hospital insurance), and you meet all of the following conditions:
- Your physician certifies that you are terminally ill and have a life expectancy of six months or less.
- You decline curative treatment for your illness and instead elect to receive comfort care.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness.
Example: Would Justine qualify for home health coverage?
Justine’s physician certified that she now has six or less months left to live due to her cardiovascular disease.
Justine is tired of spending her time in medical facilities like hospitals and physician offices. She opts to not pursue any kind of curative treatment and would like to instead focus on comfort and pain management in her last months of life.
Since Justine has Medicare Part A, has had a physician certify her illness is terminal and she declines all curative treatment, she would qualify for hospice coverage under Medicare.
Hospice care is often misunderstood and many families have preconceived notions about what hospice care is. To learn more about the common misconceptions surrounding hospice care, click here.
What hospice services are covered under Medicare?
Depending on your or your loved one’s illness and health care status, the hospice care team will put together an interdisciplinary team to help you and your loved ones through the end-of-life transition.
Covered hospice care services include:
- Pain relief and symptom management
- Medications related to terminal illness
- Medical, nursing and social services
- Durable medical equipment (DME)
- Aide and homemaker services
- Spiritual care for patients and loved ones
Medicare will more than likely cover other services recommended by your or your loved one’s hospice care team, like managing your pain or other symptoms related to your illness.
Medicare will not cover any of the following services:
- Curative treatment for your illness
- Prescription drugs for your illness
- Care from other hospice providers that wasn’t set up by your hospice medical team
- Room and board
- Emergency room or hospital inpatient care
Example: Would Miguel qualify for hospice coverage?
Miguel’s doctor diagnosed him with lung cancer and gave him a life expectancy of six months.
Miguel chose to pursue treatment to try and further extend his life expectancy. He regularly undergoes chemotherapy and radiation.
Since Miguel is actively pursuing treatment for his disease, he would not qualify for hospice coverage under Medicare.
Hospice is not a permanent choice and if at any point you or your loved one decide to resume curative treatment, you always have the right to do so, but the services may not be covered under the hospice benefit.
How much does hospice cost with Medicare coverage?
Once you or your loved one chooses hospice care and all of the qualifying conditions are met, you should discuss with your hospice provider what hospice care services you will receive and whether Medicare will cover them. For example, your hospice provider should go over costs and discuss with you whether any drugs or services aren’t covered by your hospice benefit.
You may also have to pay for room and board if choosing to receive care in a facility such as a skilled nursing facility.
It’s important to note that each person’s situation is different. Although Medicare.gov states that Medicare will cover the costs of everything related to your or your loved one’s terminal illness, there are a few circumstances that may interfere with full Medicare coverage and require payment.
The specific amount owed may depend on other factors such as:
- Other insurance you have
- How much your doctor charges
- If your physician accepts assignment, meaning they accept the Medicare-approved amount as full payment for a covered service
- The type of facility you are receiving care from
- Where you go for a test, item or service
Please always consult your physician or health care provider and ask questions to understand the need for certain services and whether Medicare will pay for them.
How do I find Medicare-certified hospice care?
Medicare makes it easy to find certified hospice care. You can visit Medicare.gov to search for a qualified hospice provider near you.
Enhabit Home Health & Hospice is the fourth-largest Medicare-certified home health and hospice provider in the nation. Visit our website to find a location near you and talk to your physician about a referral to our services.
At Enhabit our patients are our number one priority. From providing the latest medical practices to building deep personal connections, we’re focused on upholding every patient’s dignity, humanity and sense of control on their health care journey.
Our home health services give patients access to the care they deserve in the comfort of their own homes. From disease and injury management to recovery from surgery, our clinicians help patients confidently achieve their healthcare goals.
Our hospice care services place importance on the comfort of every patient living with a terminal illness. Our caring professionals are dedicated to providing not just physical care, but spiritual and emotional support to every patient and their loved ones.