Does Medicare Cover Hospice? Exploring Your Options

The decision to seek hospice care is a difficult one, but it can provide the best quality of life for those facing terminal life-limiting illnesses. In hospice, the focus shifts from providing curative treatment to delivering comfort and compassionate, supportive care. Medicare offers hospice benefits to plan holders to help them receive these services. While understanding Medicare coverage can sometimes be confusing, hospice benefits are relatively straightforward. Learning more about Medicare and end-of-life care will help you and your family understand what to expect regarding expenses, hospice treatments and how long you can expect to be covered.

Medicare Qualifications for Hospice

Hospice care provides many benefits for patients and their families. For those who are terminally ill, hospice can provide effective pain relief and dignified care while facilitating closure for both the patient and their family as they near the end of life.

To qualify for hospice under Medicare, you must be:

• Enrolled in Medicare Part A
• Certified to be terminally ill by a physician
• Have a life expectancy of less than six months

Hospice utilizes a multidisciplinary approach to address patients' emotional, physical and spiritual needs and honors their goals and wishes as they enter this phase of life. Specialized support is also given to families through education, opportunities for respite care, assistance with daily care and grief support. With hospice care, patients can live out their last days more comfortably than they would if they continued with curative treatment until their passing.

Is Hospice Completely Covered by Medicare?

For the most part, Medicare covers hospice care in full as long as you receive services through a Medicare-approved hospice provider. However, there are some caveats to consider:

• Hospice is covered for those enrolled in Medicare Part A. 
• If Part A denies any medication coverage, Medicare Part D may cover them.
• Medicare Advantage plans (Part C) may also cover additional medications or treatments that Part A does not cover.
• A Medigap plan can cover deductibles and additional costs not covered by other plans. However, it does not cover costs associated with long-term care.

Medicare Part A covers inpatient care at a hospital, home health care and hospice care. If you are enrolled in Medicare Part A, there are a few expenses to be aware of, including a copayment amounting to up to $5 per prescription drug (however, this can be covered with Medicare Part D) and a fee of up to 5% of the Medicare-approved amount billed for inpatient respite care.

It's important to remember that when patients enter hospice care, they must sign an agreement stating that further curative treatment will not be sought. If a patient or their loved one seeks treatment outside of that provided by the hospice team, it will not qualify for Medicare hospice benefits. You must work directly with the hospice team. Additionally, Medicare only pays for care received in a facility if the hospice team determines that the patient requires respite or short-term inpatient care, such as crisis care.

How Long Can You Be on Hospice With Medicare?

Hospice care isn't intended to last longer than six months. According to Medicare.gov, you may receive hospice care for two 90-day benefit periods. After these periods, the patient's hospice or primary care physician must recertify that they have a terminal diagnosis. If a patient outlives the original six-month prognosis and is recertified to be terminal, they may continue in hospice care as needed and receive an unlimited number of 60-day benefit periods. As each period ends, their physician must provide recertification.

Does Medicare Pay for Hospice at Home?

Yes, Medicare does pay for hospice care at home. With Medicare coverage, "home" is considered a person's residence and can include their private residence, residential facility or nursing home. For Medicare to pay for hospice, the program providing care must have at least 80% of the patients it sees residing at home.

Hospice care is generally covered when provided for patients enrolled under Medicare Part A. While some copayments, coinsurance fees and hospice medications may still fall under the patient's responsibility, this depends on the individual plan they are enrolled in.

Deciding whether to begin hospice care is a difficult decision for the terminally ill patient as well as their loved ones. However, hospice can offer patients the opportunity to spend their last days in comfort with compassionate care, effective management of complex pain and symptoms and invaluable support for patients and families.