Under What Circumstances Does Medicare Cover Hospice Care?Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit offers end-of-life palliative treatment, including support for your physical, emotional, and other needs. It is important to remember that the goal of hospice is to help you live comfortably, not to cure an illness.

 To elect hospice, you must:

  •  Be enrolled in Medicare Part A.
  •  Have a hospice doctor certify that you have a terminal illness, meaning a life expectancy of six months or less.
  •  Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care.
  •  And, receive care from a Medicare-certified hospice agency.

 Once you choose hospice, all of your hospice-related services are covered under Original Medicare, even if you are enrolled in a Medicare Advantage Plan. Your Medicare Advantage Plan will continue to pay for any care that is unrelated to your terminal condition. Hospice should also cover any prescription drugs you need for pain and symptom management related to your terminal condition. Your stand-alone Part D plan or Medicare Advantage drug coverage may cover medications that are unrelated to your terminal condition.

 The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods, pending recertification by a doctor.

 If you are interested in Medicare’s hospice benefit:

  •  Ask your doctor whether you meet the eligibility criteria for Medicare-covered hospice care.
  •  Ask your doctor to contact a Medicare-certified hospice on your behalf.
  •  Be persistent. There may be several Medicare-certified hospice agencies in your area. If the first one you contact is unable to help you, contact another.

 Once you have found a Medicare-certified hospice:

  •  The hospice medical director (and your doctor if you have one) will certify that you are eligible for hospice care. Afterwards, you must sign a statement electing hospice care and waiving curative treatments for your terminal illness.
  •  Your hospice team must consult with you (and your primary care provider, if you wish) to develop a plan of care. Your team may include a hospice doctor, a registered nurse, a social worker, and a counselor.

 If you qualify for the hospice benefit, Medicare covers the following:

  •  Skilled nursing services, which are services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness. Services you may receive include injections (and teaching you to self-inject), tube feedings, catheter changes, observation and assessment of your condition, management and evaluation of your care plan, and wound care.
  •  Skilled therapy services, which are physical, speech, and occupational therapy services that are reasonable and necessary to manage your symptoms or help maintain your ability to function and carry out activities of daily living (eating, dressing, toileting). These services must be performed by or under the supervision of a licensed therapist.
  •  Hospice aides and homemaker services, including full coverage of a hospice aide to provide personal care services, including help with bathing, toileting, and dressing, as well as some homemaker services (changing the bed, light cleaning and laundry).
  •  Medical supplies, including full coverage of certain medical supplies, such as wound dressings and catheters.
  •  Durable medical equipment (DME), including full coverage of equipment needed to relieve pain or manage your terminal medical condition.
  •  Respite care, which means short-term inpatient stays for you that allow your caregiver to rest. This coverage includes up to five consecutive inpatient days at a time. You will pay a copayment of no more than 5% of the Medicare-approved amount for each day. Your total copays for respite care should be no more than the inpatient hospital deductible amount for the year you first elected hospice care.
  •  Short-term inpatient care, which is care at a hospital, SNF, or hospice inpatient facility if your medical condition calls for a short-term stay for pain control or acute or chronic symptom management. Only covered if care cannot feasibly be provided in another setting.
  •  Medical social services, including full coverage of services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This may include counseling and/or help finding resources in your community.
  •  Prescription drugs related to pain relief and symptom control. You pay a $5 copay.
  •  Spiritual or religious counseling
  •  Nutrition and dietary counseling

 While you are receiving care under the Medicare hospice benefit, you can still get Medicare coverage for treatment of illnesses and injuries unrelated to your terminal condition. Coverage for such care would be provided however you received benefits prior to hospice, either through Original Medicare or Medicare Advantage, and you should expect to pay normal cost-sharing amounts.

Read More: What is Considered a Benefit Period?
Learn About: What Does Lifetime Reserve Days Mean?
Return to: Medicare In-Depth

Under What Circumstances Does Medicare Cover Hospice Care?Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit offers end-of-life palliative treatment, including support for your physical, emotional, and other needs. It is important to remember that the goal of hospice is to help you live comfortably, not to cure an illness.

 To elect hospice, you must:

  •  Be enrolled in Medicare Part A.
  •  Have a hospice doctor certify that you have a terminal illness, meaning a life expectancy of six months or less.
  •  Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care.
  •  And, receive care from a Medicare-certified hospice agency.

 Once you choose hospice, all of your hospice-related services are covered under Original Medicare, even if you are enrolled in a Medicare Advantage Plan. Your Medicare Advantage Plan will continue to pay for any care that is unrelated to your terminal condition. Hospice should also cover any prescription drugs you need for pain and symptom management related to your terminal condition. Your stand-alone Part D plan or Medicare Advantage drug coverage may cover medications that are unrelated to your terminal condition.

 The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods, pending recertification by a doctor.

 If you are interested in Medicare’s hospice benefit:

  •  Ask your doctor whether you meet the eligibility criteria for Medicare-covered hospice care.
  •  Ask your doctor to contact a Medicare-certified hospice on your behalf.
  •  Be persistent. There may be several Medicare-certified hospice agencies in your area. If the first one you contact is unable to help you, contact another.

 Once you have found a Medicare-certified hospice:

  •  The hospice medical director (and your doctor if you have one) will certify that you are eligible for hospice care. Afterwards, you must sign a statement electing hospice care and waiving curative treatments for your terminal illness.
  •  Your hospice team must consult with you (and your primary care provider, if you wish) to develop a plan of care. Your team may include a hospice doctor, a registered nurse, a social worker, and a counselor.

 If you qualify for the hospice benefit, Medicare covers the following:

  •  Skilled nursing services, which are services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness. Services you may receive include injections (and teaching you to self-inject), tube feedings, catheter changes, observation and assessment of your condition, management and evaluation of your care plan, and wound care.
  •  Skilled therapy services, which are physical, speech, and occupational therapy services that are reasonable and necessary to manage your symptoms or help maintain your ability to function and carry out activities of daily living (eating, dressing, toileting). These services must be performed by or under the supervision of a licensed therapist.
  •  Hospice aides and homemaker services, including full coverage of a hospice aide to provide personal care services, including help with bathing, toileting, and dressing, as well as some homemaker services (changing the bed, light cleaning and laundry).
  •  Medical supplies, including full coverage of certain medical supplies, such as wound dressings and catheters.
  •  Durable medical equipment (DME), including full coverage of equipment needed to relieve pain or manage your terminal medical condition.
  •  Respite care, which means short-term inpatient stays for you that allow your caregiver to rest. This coverage includes up to five consecutive inpatient days at a time. You will pay a copayment of no more than 5% of the Medicare-approved amount for each day. Your total copays for respite care should be no more than the inpatient hospital deductible amount for the year you first elected hospice care.
  •  Short-term inpatient care, which is care at a hospital, SNF, or hospice inpatient facility if your medical condition calls for a short-term stay for pain control or acute or chronic symptom management. Only covered if care cannot feasibly be provided in another setting.
  •  Medical social services, including full coverage of services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This may include counseling and/or help finding resources in your community.
  •  Prescription drugs related to pain relief and symptom control. You pay a $5 copay.
  •  Spiritual or religious counseling
  •  Nutrition and dietary counseling

 While you are receiving care under the Medicare hospice benefit, you can still get Medicare coverage for treatment of illnesses and injuries unrelated to your terminal condition. Coverage for such care would be provided however you received benefits prior to hospice, either through Original Medicare or Medicare Advantage, and you should expect to pay normal cost-sharing amounts.

Read More: What is Considered a Benefit Period?
Learn About: What Does Lifetime Reserve Days Mean?
Return to: Medicare In-Depth

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