Does Medicare Cover Hospice Care?

Hospice is end-of-life care for people with illnesses that can't be cured.

Once you choose hospice care, your hospice benefit should cover everything you need. You and your family will work with your hospice care team to set up your plan of care. What kinds of services does a plan of care include?

Medicare won't cover any of these once your hospice benefit starts:

• Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you're thinking about getting treatment to cure your illness. Can I stop hospice care?
• Prescription drugs to cure your illness (rather than for symptom control or pain relief).
• Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you've chosen him or her to be the attending medical professional who helps supervise your hospice care.
• Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility.
• Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it's either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

Contact your hospice team before you get any of these services or you might have to pay the entire cost.

You can ask your hospice provider for a list of items, services, and drugs that they’ve determined aren’t related to your terminal illness and related conditions. This list must include why they made that determination. Your hospice provider must give you the list within 3-5 days of your request, depending on when you made it. Your provider must also give this list to your non-hospice providers or Medicare, if requested.

You must have Part A and meet all these conditions:

• Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).
• You accept comfort care (palliative care) instead of care to cure your illness and related conditions.
• You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

When you decide to get hospice care, the hospice will have you and sing a "Hospice Election Statement." This document identifies the hospice providing your care and informs you of important information about hospice services, including the start date of the services and who you decide to be your attending doctor. This document must be completed before you get any hospice services.

Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (after a face-to-face meeting with the hospice doctor or hospice nurse practitioner) that you’re still terminally ill.

• You pay nothing for hospice care if you get your care from a Medicare-approved hospice provider. How do I know if a hospice provider is Medicare-approved?
• You pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn't cover your drug, your hospice provider should contact your plan to find out if Part D covers it. The hospice provider must inform you if any drugs or services aren’t covered and why, and if you’ll be required to pay for them.
• You may pay 5% of the Medicare-approved amount for inpatient respite care (short-term care to help give caregivers a rest). Your copayment can’t be more than the inpatient deductible amount.
• Original Medicare will still pay for covered benefits for any health problems that aren't part of your terminal illness and related conditions, but you'll owe any deductible and coinsurance amounts that apply. Once you choose hospice care, your hospice benefit will usually cover everything you need.
• You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care.
• If your hospice care team determines you need inpatient care at a hospital, they must make the arrangements for your stay. If they don’t, you might have to pay for the entire cost of your hospital care.

The hospice provider must inform you if any drugs or services aren’t covered and why, and if you’ll be required to pay for them. You can ask for an addendum to your " Hospice Election Statement ” that lists any items, services, and drugs your hospice won’t cover because they’re unrelated to your terminal illness. If your coverage changes, your hospice provider will give you an updated addendum so you can make treatment decisions that best meet your needs.

If you qualify, you can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.

You can usually get Medicare-approved hospice care in your home or other facility where you live, like an assisted living facility or a nursing home. If you meet certain conditions, can also get hospice care in an inpatient hospice facility. If your hospice care team determines you need inpatient care at a hospital, they must make the arrangements for your stay. If they don’t, you might be responsible for the entire cost of your hospital care. What's a hospice care team?