Does Medicare Pay for Hospice?

holding the hands of senior in hospice care

What is Hospice Care

Hospice care is a part of your Medicare coverage that provides patients comfort and familiarity while nearing the end of life. Fortunately for most people, the answer to “does Medicare pay for hospice,” is yes. Original Medicare will pay for hospice once you meet certain criteria.

  • Your hospice doctor and your regular doctor certify that you are terminally ill (life expectancy of six months or less).
  • You accept palliative care (comfort) instead of care to cure your illness
  • You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness and related conditions

After six months, you can continue to receive hospice care if the hospice director or your hospice doctor re-certifies that you only have a life expectancy of six months or less. Once you begin your hospice care, your benefit will usually cover everything you need.

How Does Medicare Pay for Hospice?

The costs for hospice come directly from Original Medicare, specifically Part A which covers hospice under hospital insurance. Through your hospice care team, depending on your terminal illness and related conditions, your plan can include a multitude of services:

  • Doctor services
  • Nursing care
  • Prescription drugs for symptom control and pain relief
  • Medical equipment (wheelchairs or walkers)
  • Medical supplies (bandages or catheters)
  • Hospice aid and homemaker services
  • Physical therapy services
  • Occupational therapy services
  • Speech-language pathology services
  • Social work services
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short term inpatient care for pain and symptom management
  • Short term respite care
  • Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illnesses and related conditions, as recommended by your hospice team

How Does Medicare Pay for Hospice Respite Care?

If the main caregiver (typically a family member) needs a short break from care-giving duties, you can receive inpatient respite care at a Medicare-approved facility (like a hospital, hospice inpatient facility, or nursing home). If you find yourself needing a break, your hospice provider will arrange respite care for you. Respite care can last up to five days and can be used on an occasional basis.

Things Medicare Does Not Pay for During Hospice

While Medicare does pay for hospice coverage in many ways, hospice won’t cover a few different things. These include:

  • Prescription drugs to cure your illness (this would be covered by your Part D Plan)
  • Treatment intended to cure your terminal illness
  • Care from any hospice provider outside of your hospice team
  • Room and board
  • Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation unless it arranged by the hospice team or unrelated to your illness.
Things to Consider Before Starting Hospice Care

It is important to determine if hospice care is right for you and your family during a difficult time. While there are a lot of uncertainties when it comes to Medicare coverage, hospice care shouldn’t be one of them. If at any point during your hospice care you decide you want to try to attempt to cure your illness, you have the right to stop your hospice care at any time. If you still have questions or concerns regarding Medicare paying for hospice, contact an agent who specializes in Medicare today. 

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