Hospices provide specialized care for people who are terminally ill and near the end of life. Hospice care is provided at specialized hospice facilities, nursing homes, or at home, depending on the condition and needs of the patient.

Medicare covers hospice provided you meet the eligibility requirements and use a medicare-approved provider. Medicare will cover the cost of hospice care whether you receive it at home, in a nursing home, or in any other Medicare-approved hospice facility.

If you qualify for hospice care, Medicare will cover all the costs for any care you receive that is related to the terminal illness. Hospice care is covered under Original Medicare (Medicare Part A and B).

Are you eligible for Medicare hospice benefits?

Hospice care is usually covered by Medicare in full under Medicare Part A benefits. To qualify for this coverage, you need to meet the following criteria:

1. Your doctor needs to certify that you are terminally ill and have a life expectancy of 6 months or less;
2. You sign a statement agreeing to go into hospice care instead of other Medicare-covered treatments for your terminal illness;
3. You get hospice care from a Medicare-approved hospice provider either at home or in a care facility;

What does Medicare hospice benefit cover?

If you have Medicare Part A, all your hospice care costs will be covered by your plan. Hospice services that are fully paid for by your Medicare plan include:

• Doctors’ services;
• Skilled nursing services like injections;
• Prescription drugs;
• Medical equipment required for the management of your condition; 
• Medical supplies such as catheters and bandages; 
• Physical therapy and occupational therapy;
• Home aide services;
• Speech or language therapy; 
• Counseling for you and your loved ones;
• Inpatient care in a Medicare-approved facility for pain and symptom management;
• Inpatient respite care;

How does Medicare cover hospice care?

Original Medicare covers all hospice care costs for patients who have been certified as terminally ill. Other parts of Medicare that may help cover expenses associated with hospice care include:

• Original Medicare: covers the cost of hospice services;
• Medicare Part D: may cover the cost of medications not covered by Medicare Part A;
• Medicare Advantage (Medicare Part C): covers any additional treatments or services that may not be covered by Medicare part A;
• Medigap: Helps to cover any coinsurance costs and deductibles not covered by Original Medicare;

Medicare hospice benefit exclusions

Once a patient on Original Medicare is certified to be terminally ill and in need of hospice care, the Medicare hospice benefit takes effect. However, Medicare will not cover the following costs:

• Curative prescription drugs: Original Medicare will only cover the cost of drugs given for symptom relief or pain management, but it will not cover any curative drugs to cure your condition. 
• Treatment procedures: Any services or treatments intended to cure your condition will not be covered under the Medicare hospice benefit since this benefit is only meant to cover comfort care without curative intent.
• Room and board: if you are receiving hospice care in a long-term care facility like a nursing home, Medicare does not cover the cost of room and board. If the hospice team determines that you need short-term inpatient or respite care services, Medicare will cover those costs.

Palliative care vs hospice care and Medicare 

Medicare differentiates between palliative care and hospice care in its hospice coverage. Hospice care is deemed as end-of-life care for terminally ill patients that has no curative intent but focuses on symptom and pain management. In contrast, palliative care may include curative treatments or procedures. 

Hospice care is usually end-of-life care for patients with a life expectancy of six months or less. Palliative care, on the other hand, can be pursued at any time, including during the diagnosis of an illness, in the course of treatment, or at the end of life.

The Medicare hospice benefit does not include coverage for curative prescription drugs or treatments. However, if you have Medicare Advantage or Medicare Part D, the cost of such drugs and treatment may be covered under those plans.

Medical equipment, skilled nursing care, social services, and medications for symptom and pain relief are all covered by Medicare Part A for patients in hospice care. However, for patients who need palliative care, Medicare Part B and Medicaid will cover some types of palliative care services, but copays may apply.

Medicare guidelines for hospice

Medicare covers terminally ill patients for hospice care if they are certified to have a life expectancy of six months or less. However, Medicare will continue to provide coverage for patients who live longer than six months, provided the hospice doctor recertifies that the patient is still terminally ill and requires end-of-life care.

The following guidelines apply to hospice care under Medicare:

• Medicare will cover your hospice care for two 90-day benefit periods. After this period, you will have unlimited 60-day benefit periods, provided you are still certified as terminally ill and in need of hospice care.
• Your Medicare hospice benefit allows you to change your hospice provider once within each benefit period, provided you choose a Medicare-approved hospice provider. However, you cannot change providers multiple times within the same benefit period. 
• Your doctor or primary physician needs to certify at the beginning of each benefit period that you are terminally ill so that Medicare can continue to cover the costs of your hospice care.

How much does hospice cost with Medicare?

Hospice care is usually covered under Medicare Part A benefits. If you qualify for hospice benefits under Medicare, you will incur the following costs:

• Your monthly Medicare Part A and Medicare Part B premiums;
• All hospice costs will be covered by Medicare, including medical and nursing services, medical equipment, and any therapy services. There are no deductibles for these services; 
• You will incur copayments of up to $5 for prescription drugs for pain and symptom management; Curative drugs are not covered and will need to be paid for out of pocket or covered by Medicare Part D or Medicare advantage; 
• You will pay 5% of the Medicare-approved cost of inpatient respite care;
• You will cover the costs of room and board if you are in a long-term care facility since these are not included in Medicare hospice benefits.;

Medicare Advantage and hospice

Medicare covers hospice care under Original Medicare benefits, even for patients who have a Medicare Advantage plan or Medicare Part C. 

If you have Medicare Advantage, you will continue to receive the added coverages of your plan, like vision and dental care, even while in hospice care. Medicare Advantage may also cover the cost of prescription drugs that are not covered by Medicare Part A, including medications for conditions that are not related to your terminal illness. 

Finding a Medicare-approved hospice provider

If you are eligible for the Medicare hospice benefit, you can find and compare Medicare-approved hospice providers in your area. It is important to pick a provider that is Medicare-approved since Medicare will not cover hospice costs from providers not on their list. 

As a beneficiary of Medicare, you can change your hospice provider once every benefit period. This means that if you are not satisfied with the quality of care or need to switch providers for any other reasons, you have the option to do so. 

Medicare-certified hospice providers can provide hospice care in your home, in a long-term care facility like a nursing home or an inpatient hospice facility. The best option for you will be determined by your doctor and hospice team based on your condition and circumstances.

Stopping hospice care

If your condition is no longer terminal and you no longer need hospice care, you can opt out at any time. You will need to submit a form officially stipulating the date you want to stop hospice care. Your Medicare benefits will remain the same after ending hospice care. 

If after stopping Medicare you fall ill again and require hospice care, you can go back to hospice care at any time, provided you meet the eligibility requirements.