How does Medicare cover hospice care?
What Medicare benefits are available if I require hospice care?
Medicare provides comprehensive coverage for hospice care under Medicare Part A (hospital insurance). Hospice care is designed to offer comfort and support to individuals with a terminal illness who are expected to live six months or less. The goal of hospice care is to focus on pain management and symptom relief, rather than curative treatments. Here’s what you need to know about the hospice benefits available through Medicare:
1. Eligibility for Medicare-Covered Hospice Care:
To qualify for Medicare hospice benefits, the following conditions must be met:
You must be eligible for Medicare Part A.
Your doctor and the hospice medical director must certify that you have a terminal illness and are expected to live six months or less if the illness runs its normal course.
You must choose to receive palliative care (relief from pain and symptoms) rather than curative treatments for your terminal illness.
You must sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal condition.
Once you’ve chosen hospice care, Medicare will cover almost all of your care related to your terminal illness, allowing you to focus on comfort and quality of life.
2. What Hospice Care Includes:
Medicare’s hospice benefit covers a wide range of services to manage your terminal illness and provide support to you and your family. Covered services include:
Doctor and nursing care: Ongoing visits from hospice doctors and nurses to manage your pain and symptoms.
Prescription drugs: Medications necessary for pain relief and symptom management related to your terminal illness. Medicare covers these medications under hospice care, though you may be responsible for a copayment of no more than $5 per prescription.
Medical equipment: Medicare covers durable medical equipment (such as hospital beds, wheelchairs, walkers) that you may need for your care.
Medical supplies: Items like bandages and catheters are covered.
Physical, occupational, and speech therapy: Therapies designed to help manage your symptoms and improve your quality of life.
Home health aide services: Personal care assistance (such as help with bathing, dressing, and grooming) provided by a hospice aide.
Social worker services: Support for emotional and practical needs, including counseling and help with end-of-life planning.
Respite care: Short-term inpatient care to provide your family or caregivers with temporary relief. Respite care is covered for up to five days at a time.
Spiritual and grief counseling: Bereavement counseling and support for you and your family members, both during hospice care and for up to one year after your death.
Inpatient care for symptom control: If your symptoms cannot be managed at home, Medicare covers short-term inpatient care at a Medicare-approved hospice facility, hospital, or skilled nursing facility.
Respite care for caregivers: Your caregivers can receive temporary relief through respite care services, allowing them to take a break while you receive care in a hospice facility.
3. Cost of Hospice Care Under Medicare:
Hospice care is covered by Medicare at little to no cost to you. You do not pay a deductible or coinsurance for hospice services.
Medications: You may pay a copayment of up to $5 for each prescription drug related to your terminal illness.
Respite care: You may need to pay 5% of the Medicare-approved amount for inpatient respite care. This is typically a small amount compared to the overall cost of care.
Room and board: Medicare does not cover room and board if you receive hospice care in your home or at a nursing home or assisted living facility, unless the care is for a short-term inpatient stay or respite care.
4. Where You Can Receive Hospice Care:
You can receive Medicare-covered hospice care in a variety of settings, depending on your preferences and care needs:
At home: Most people receive hospice care in their home, allowing them to stay in familiar surroundings with the support of family or caregivers.
Inpatient hospice facility: If your symptoms cannot be managed at home or you require more intensive care, you may receive hospice care in a specialized hospice facility.
Skilled nursing facility: If you are already living in a skilled nursing facility or nursing home, Medicare will cover hospice care provided there, but it will not cover the cost of room and board unless it’s for inpatient respite care.
5. What Is Not Covered by Medicare Hospice Care:
Curative treatment: Once you choose hospice care, Medicare does not cover treatments aimed at curing your terminal illness. The focus is on comfort and managing symptoms.
Care not related to your terminal illness: Medicare will continue to cover treatments for conditions unrelated to your terminal illness. For example, if you need care for a chronic condition like diabetes, those services would still be covered under your Medicare benefits.
Room and board: Medicare does not pay for room and board in your home, nursing home, or assisted living facility, except during periods of inpatient respite care or when you need short-term inpatient care for symptom management.
6. How Long You Can Receive Hospice Care:
Hospice care is provided in periods of care, typically starting with two 90-day periods, followed by an unlimited number of 60-day periods as long as your doctor continues to certify that you are terminally ill.
If you live beyond six months but still need hospice care, Medicare will continue to cover your care, as long as your doctor certifies that your condition remains terminal.
7. Switching Back to Regular Medicare Care:
If you decide to stop hospice care and pursue curative treatments, you can revoke your hospice benefit at any time and return to receiving regular Medicare services.
If your condition improves, you can also choose to disenroll from hospice care and resume normal Medicare coverage, including Part A and Part B benefits.
Key Takeaways:
Medicare Part A covers hospice care for individuals with a terminal illness, providing a range of services focused on comfort and symptom management.
Hospice care can be provided at home, in a hospice facility, or in a skilled nursing facility.
Medicare covers almost all hospice-related services at little to no cost, but does not cover curative treatments or room and board.
You can leave hospice care at any time if you choose to pursue curative treatments or if your condition improves.
For personalized guidance on Medicare-covered hospice services or to understand your options, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
