Medicare and Hospice Care

Hospice is a program of care and support for people who are terminally ill. The focus ofHospice Care hospice care is on ensuring patient comfort, and not on curing an illness. In hospice, a specially trained team of professionals and caregivers provide care for the “whole person,” including physical, emotional, social, and spiritual needs. There are hospice facilities, but hospice care is generally provided in the home. Medicare can help cover some of the hospice care costs.

Hospice care can be a blessing for those suffering from a terminal medical condition and can even include specialized care, such as reading to a patient, playing music, and companionship. Hospice care providers can also provide respite for caregivers.

Medicare recognizes the importance of hospice and covers it fully. Meaning even if you only get Medicare Part A (hospital coverage), which is the minimum Medicare coverage, you will be fully covered for hospice care. Once you start getting hospice care, your Medicare hospice benefit should cover everything you need related to your terminal illness if your care comes from a Medicare-approved hospice provider. If, while in hospice, you need care that is not associated with your terminal illness (for instance, you fall and break your arm), you would be covered by your regular Medicare or Medicare Advantage plan benefits.

If you have determined that you no longer want to pursue curative treatment for your medical condition, you should discuss your decision with your health care team. Your health care team can help you coordinate hospice care. You always have the right to stop hospice care, and seek a curative treatment, at any time.

However, while in care of a Medicare-approved hospice provider, Medicare will not cover any of the following:

  • Prescription drugs (except for symptom control or pain relief).
  • Care from any provider that wasn’t set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness and related conditions must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.
  • Room and board. Medicare doesn’t cover room and board. However, if the hospice team determines that 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.
  • Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

For more information on hospice care, please review: Hospice FAQs from the National Hospice and Palliative Care Organization.

For more information about Medicare’s coverage of hospice benefits, you can read: Medicare Hospice Benefits.