What you need to know about hospice care
Medicare covers hospice care if you meet eligibility requirements, including certification of a terminal illness (six months or less life expectancy) and choosing comfort care instead of curative treatment. Most hospice services are fully covered, though small copayments or room and board costs may apply in certain situations.
Qualifications for getting hospice care through Medicare
Original Medicare (Parts A and B) covers care related to terminal illness. You’ll need to meet certain qualifications to get coverage through Medicare.
These include:
Your hospice doctor and primary care provider both certify that you are terminally ill
You accept palliative benefits (care for comfort) instead of care that tries to cure your illness
- You have signed a statement of your choice to receive hospice care instead of other treatments Medicare covers
Learn how an Institutional Special Needs Plan (I-SNP) may help cover care in certain settings.
What hospice benefits does Medicare cover?
Most people receive hospice at home. During this time, Medicare Parts A and B still cover health problems unrelated to terminal illness.
Other hospice benefits under Medicare may include:
Hospice aid and homemaker services
Social worker services
Services from a doctor and/or physician assistant
Prescription drugs aiding comfort or symptom control
Dietary counseling
Physician and occupational therapy
Grief counseling
What hospice services does Medicare not cover?
A wide range of care can go into the hospice experience. But not everything is covered by Medicare.
Here’s what isn’t covered:
- Curative care (care meant to cure illness)
- Prescription drugs meant to cure illness
- Care from a hospice provider that wasn’t set up by your hospice medical team
- Room and board (if you do not receive hospice at home)
- Outpatient or inpatient hospital care and ambulance transportation
Compare Medicare coverages to better understand what is and isn’t included in plan options
Cost of hospice care with Medicare coverage
If you qualify, your care is usually completely covered. But there are some potential hospice nursing care costs to plan for. You may have a copayment of up to $5 for drugs helping with pain and symptom relief. In unusual cases where your drug is not covered, your provider will check if Medicare Part D covers it. If Part D does not cover it, you will pay the full cost. You may also pay 5% of the Medicare approved amount for respite care (short term care that gives care givers a break). If you do not receive in-home hospice care, your hospice costs could include room and board.
Explore your Medicare options for hospice care
A little planning goes a long way. Review Medicare hospice eligibility requirements and enroll in Medicare Parts A and B if you haven’t already done so. Be sure to speak to loved ones about care options and find a provider you trust.
Ready to explore plans that fit your needs? Shop Medicare plans near you.
