Choosing hospice care can be a difficult decision. What shouldn’t be difficult is knowing what hospice services your Medicare insurance covers. We are here to help.
To receive hospice care, at least one physician must certify that the patient is expected to live for six months or less from their illness. Appropriate physicians are the hospice medical director and the attending physician. Keep in mind that if your usual medical provider is a nurse practitioner, s/he cannot certify you for hospice care.
Once you are certified, Original Medicare (Part A) will begin to cover your hospice care. Even if you were previously in a Medicare Advantage Plan, you will still receive all the coverage Original Medicare offers hospice patients. And so long as you pay your premiums, you will be covered for any extra services your Medicare Advantage Plan covers that are not related to curing your illness—like dental and vision. If you leave hospice care, you can resume your usual coverage with Medicare Advantage the following month.
The hospice services covered by Medicare typically include:
- Doctor and nursing care
- Hospice aide services
- Social work services
- Medical equipment and supplies
- Prescription drugs for pain relief and symptom management
- Physical therapy
- Spiritual needs, like chaplain services
- Grief counseling
Medicare will also help cover short-term hospital stays and respite services. If your caregivers take a vacation or need a rest, your short stay in a nursing home, hospital, or other facility will be covered. You may need to make a small copayment, however. You may also need to make copayments (under $5 ) for prescription drugs. For health services covered by Medicare that are not related to your terminal condition, you will receive care from your hospice team but pay standard deductible and coinsurance amounts.
What Medicare won’t cover
Medicare will not cover any medications or treatments intended to cure your terminal condition, nor will it cover room and board. So if you receive hospice care in a nursing home or hospice facility, you will be responsible for paying for your room. Medicare will also not cover any hospice care from providers that are not approved by Medicare. You should search for health care professionals who accept Medicare. You can also search for which hospitals or other facilities accept Medicare.
There is no need to worry if you need hospice care for more than six months. Medicare covers hospice care for two 90 day benefit periods, and then an unlimited number of 60 day benefit periods as needed. All you need to do to ensure you’re still covered is have a hospice doctor re-certify that you are terminally ill each benefit period. If your illness goes into remission or you improve, you can stop receiving hospice care and then resume it if your condition worsens. You can also change health care providers once each benefit period.
Hospice care is meant to provide comfort, to ease the strain of dealing with a terminal illness. Getting the appropriate coverage for your needs should help with those goals.