Hospice is a program of care and support for people who are terminally ill (a life expectancy of 6 months or less). Original Medicare does help cover some costs of hospice care but there are eligibility requirements to qualify.
Let’s take a look at the eligibility requirements, which parts of Medicare help pay for hospice care and more.
Medicare eligibility requirements for hospice care
You qualify for hospice care if you have Medicare Part A (Hospital Insurance) and meet all of these conditions:1
- Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill.
- You accept comfort care (palliative care) instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
Medicare coverage starts the day you begin to get hospice care.2
Which parts of Medicare pay for hospice care?
Original Medicare can cover everything you need related to your terminal illness. If you were in a Medicare Advantage plan or other Medicare health plan before starting hospice, Original Medicare will still cover these services if you choose to remain in that plan.3
Which services are covered by Medicare’s hospice benefit?
Depending on your illness and symptoms, some items and services that may be covered include:4
- Nursing care
- Hospice aide and homemaker services
- Social worker services
- Medical equipment and supplies
- Doctor/Physician Assistant services
- Prescription drugs for symptom control or pain relief
- Dietary counseling
- Physical and occupational therapy
- Speech-language pathology services (like to help with swallowing)
- Grief and loss counseling
Which services are not covered by Medicare’s hospice benefit?
Medicare will not cover these items and services once your hospice benefit starts:5
- Treatment intended to cure your terminal illness and/or related conditions
- Prescription drugs that aren’t for your terminal illness or related conditions
- Care from any provider that wasn’t set up by the hospice medical team
- Room and board*
- Care you get as a hospital outpatient (e.g., emergency room), care you get as a hospital inpatient or ambulance transportation†
*If your hospice team decides you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.6
†Medicare may cover these services if your hospice team arranges it or it’s unrelated to your terminal illness and related conditions.7
Is there a copayment for Medicare hospice coverage?
If you have Original Medicare, you pay nothing for hospice care. However, if you need a prescription for outpatient drugs for pain and symptom management, you will pay a copayment of up to $5 for each prescription.8
Also, if you need inpatient respite care you may pay 5% of the Medicare-approved amount. And if you live in a facility (e.g., nursing home) and choose to get hospice care, you may have to pay your room and board.9
How to find Medicare hospice care
To find Medicare-certified hospices that serve your area, use this Medicare.gov online search tool.
How long will Medicare pay for hospice care?
Hospice care is for people with a life expectancy of 6 months or less. You can get hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods.10
At the start of the first 90-day benefit period, your hospice doctor and your regular doctor must certify that you’re terminally ill. At the start of each benefit period after the first 90-day period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill to continue receiving hospice care.11
If you live longer than 6 months, you can still get paid hospice care if the hospice medical director or other hospice doctor recertifies that you’re terminally ill.12
Note: You have the right to stop hospice care at any time. If you’d like to restart hospice care, you may do so at any time if you’re still eligible.13
Understanding your hospice care options
Choosing to start hospice care can be a difficult decision. We hope this article helps you understand the ways Medicare can cover hospice care and assists you in finding the end-of-life care you or a loved one deserves.
To learn about hospice services offered by Humana, visit our hospice care at home page.