Understanding the details of Medicare coverage for various health conditions can be challenging and frustrating, especially when a person’s need for care is time-sensitive.

Does Medicare cover hospice? The short answer is yes. Today’s guide walks you through all the aspects of the Medicare hospice benefit.

Key Takeaways:
*Medicare covers comprehensive hospice care for patients with terminal illnesses who meet specific eligibility criteria.
*Medicare provides four distinct levels of hospice care to suit the varying needs of patients.
*Patients typically face low out-of-pocket expenses, with some copayments for medications and respite care.
*Hospice care under Medicare is primarily home-based, but it can also be provided in specialized facilities if necessary.

From the included services and the eligibility conditions to the coverage period and the approved locations, we take an in-depth look at how you can benefit from Medicare’s hospice services options if you or a loved one have a terminal diagnosis.

Does Medicare Pay for Hospice Care? 

The answer is yes. Medicare covers nearly all aspects of hospice care for eligible patients with a terminal illness, including medical services, therapies, and support for pain management and symptom control.

If you or your loved one are suffering from a terminal illness, Medicare will provide coverage for nearly all facets of hospice care as long as you’re eligible to receive it.

According to the NHPCO (National Hospice and Palliative Care Organization), the number of Medicare beneficiaries who received hospice care increased from 1.43 million in 2016 to 1.72 million in 2020. 

When it comes to gender, more than half the total number (52.7 percent) of Medicare decedents who used hospice are females (vs nearly 43 percent who were males).

As for age, the majority (59 percent) of Medicare beneficiaries of hospice care were 85 years and older. Patients younger than 65 represent only 26.5 percent.

The most common principal diagnoses for Medicare hospice beneficiaries are grouped under the following major disease categories:

  • Alzheimer’s, Dementia, and Parkinson’s
  • Circulatory/Heart
  • Cancer
  • Respiratory
  • Stroke
  • Kidney disease
  • Severe Malnutrition

Choosing to begin hospice care is a tough decision, but in many cases, it’s the best move for the patient and their loved ones.

As you can tell from the information above, receiving hospice care is common. If you’re not sure what hospice care entails, here’s what that means:

What Is Hospice Care?

Regarded as the golden standard for providing quality and compassionate care for people with a terminal illness, hospice care is a program designed to support patients dealing with a life-limiting condition and their families. 

Hospice care typically involves access to pain management, professional medical care, and emotional and spiritual support in line with the patient’s wishes.

It’s important to understand that hospice care aims to deliver terminally ill patients with the highest possible level of comfort. It doesn’t focus on curing the patient.

A team of expert health professionals and caregivers work together to give the patient the needed care, whether physical, social, emotional, or spiritual. Hospice care usually includes medications, physical care, medical equipment, and counseling.

In most cases, patients receive hospice care in their private residences. Despite popular belief, cancer patients aren’t the only terminally ill people entitled to hospice care.

Does Medicare Pay For Palliative Care?

Palliative care is concerned with preserving and boosting the patient’s independence, especially when accessing health-related information and making healthcare decisions. This can involve physical, intellectual, social, and emotional needs.

Focused on helping terminally ill patients -and their loved ones- maintain a comfortable quality of life, palliative care is an integral part of hospice care. As such, Medicare does cover it.

Levels of Hospice Care

Patients suffering from life-limiting illnesses don’t necessarily face the same conditions, symptoms, severity of symptoms, or rate of disease progression. Consequently, the intensity of care that one patient needs can differ from the next.

For this reason, Medicare has 4 levels of care within the hospice care category that a patient can fall under during the course of their terminal illness.

A person can start hospice care at any of these care levels, and they can also move between them depending on changes in their health status.

Here’s a breakdown of Medicare’s hospice levels of care:

  1. RHC (Routine Home Care)
    This is the most common care level in hospice and is typically provided at home. In routine home care, the patient’s condition is stable overall, and their symptoms -such as pain and vomiting- are sufficiently under control.
  2. CHC (Continuous Home Care)
    This level of care represents a crisis-like care intensity where short-term management is provided at home for patients with out-of-control pain and/or symptoms. Continuous home care is given between 8 to 24 hours per-day and deals with acute symptoms. It involves nursing care and caregiver services.
  3. GIP (General Inpatient Care)
    Similar to CHC, this is a crisis-like care level where short-term management is given to patients with out-of-control pain and/or other acute symptoms. But instead of providing care at the patient’s private residence, GIP is provided in a medical facility such as a nursing home or hospital to achieve an inpatient setting. GIP starts when efforts to manage symptoms aren’t effective enough. It’s provided 24 hours a day.
  4. IRC (Inpatient Respite Care)
    This level of hospice care is directed toward the needs of the primary caregiver, not the patient. It aims to deliver temporary care for the patient in a nursing home, hospital, or hospice-inpatient facility where 24-hour care is accessible. IRC allows the caregiver to take some time off without depriving the patient of the necessary care.

How Does a Person Qualify for Hospice Care?

To qualify for hospice care as a Medicare beneficiary, you should meet all of the following criteria:

  • You have Medicare Part A (hospital insurance; covers inpatient stays in hospitals, care in a nursing home, and hospice care along with certain degrees of healthcare at home.
  • Your regular doctor (if available) and a hospice physician formally confirm with a statement that you’re terminally ill (with an estimated six months left to live).
  • You accept that hospice care provides comfort care (maintains the quality of life), not care to try to cure your condition.
  • You sign a document to confirm your decision to receive hospice care rather than other Medicare-covered care types for your terminal illness and related conditions.

To sum up, you can qualify for Medicare hospice care if you have Medicare Part A and verify you’re looking for comfort care, not seeking treatment to cure your terminal illness.

Obtaining Medicare Coverage for Hospice Care

Along with your hospice provider, you and your caregivers will create a care plan that meets your needs if you are eligible for Medicare coverage for hospice care.

The hospice provider you choose must be approved by Medicare. You can ask your doctor, hospice provider, state health department, or state hospice organization for information on whether a hospice provider is Medicare-approved.

If you’re enrolled in a Medicare Advantage Plan and looking to receive hospice care, request your plan to give you a list of Medicare-approved hospice providers in your area.

In addition to the patient and their family/loved ones, the patient’s hospice healthcare team may also include doctors, counselors, pharmacists, nurses (or nurse practitioners), social workers, physical therapists, homemakers, speech-language pathologists, hospice aides, and volunteers.

Additionally, the patient has access to a hospice doctor and nurse who are on call 24/7 to provide care and support to them and their families whenever needed.

The patient can choose their regular doctor, a physician assistant, or a nurse practitioner as the attending medical professional. 

What Does Medicare Cover in Hospice Care?

The patient’s hospice team will work out a care plan depending on their terminal illness and related conditions.

Medicare covers a single consultation with a hospice doctor or a hospice director. You can discuss care options and how to manage pain and/or other symptoms. This one-time consultation is available even if you don’t opt for hospice care.

Once you enter hospice care, Original Medicare will provide comprehensive coverage of everything you need to deal with your terminal condition. These include any or all of the following services:

  • Nursing care
  • Physical and occupational therapy
  • Speech-language pathology services
  • Hospice aide services
  • Homemaker services
  • Doctor services
  • Medical equipment (such as walkers or wheelchairs)
  • Short-term inpatient care (for pain and symptom management)
  • Medical supplies (such as catheters and bandages)
  • Short-term respite care
  • Prescription drugs
  • Social worker services
  • Grief and loss counseling for you and your family
  • Dietary counseling
  • Any additional Medicare-covered services required to manage your terminal sickness and related conditions, as per the recommendations of your hospice team

If you choose to stay in a Medicare Advantage Plan or another Medicare health plan, Original Medicare will cover all those services as long as they’re from a hospice provider approved by Medicare.

You can remain in your plan provided that you pay the required fees, and this plan can still cover services unrelated to your terminal illness or relevant conditions. You can also receive services from Medicare or your plan’s network providers.

Does Medicare Cover Respite Care?

Yes, Medicare offers the option to receive respite care under its coverage. The aim is to allow the patient’s usual caregiver to take some time off to rest.

You can get respite care in an inpatient setting in a Medicare-approved facility, with a length of stay of 5 days per respite care. While you can enter respite care multiple times, you can only do so occasionally.

What Costs Will the Patient Pay?

Your hospice provider will receive compensation for your hospice care directly from Medicare without deductibles.

Original Medicare will pay for all the services that are necessary to help you cope with your terminal illness and related conditions.

That said, you’ll need to pay the monthly fees for Medicare Part A and Medicare Part B. You must also pay $5 as a copayment per prescription for outpatient medications to manage pain and other symptoms, but your Medicare supplement insurance may cover that cost.

Additionally, you may have to pay 5 percent of the amount approved by Medicare for inpatient respite care.

What Does Medicare Not Cover in Hospice Care

Entering hospice care means that you don’t want to pursue treatment to cure your terminal disease and related conditions and/or your doctor has concluded that efforts for curing aren’t effective.

As such, the following items are not included in Medicare hospice coverage:

  • Any treatment intended to cure your terminal sickness and/or linked conditions. If you’re considering this, know that you’re entitled to exit hospice care at any point.
  • Prescription medications that aren’t meant for your terminal illness or related diseases.
  • Prescription medications that are intended to cure your terminal sickness and/or linked conditions.
  • Care from hospice providers not approved by Medicare or any provider that wasn’t determined by your hospice medical care team.
  • Once you choose a hospice provider, all your hospice care services must be provided through that provider. Unless you officially change your hospice provider, you can’t receive the same service from a different provider.
  • Unless your hospice team determines and arranges for it, Medicare won’t pay for hospital inpatient care, hospital outpatient care, or ambulance transportation unrelated to your terminal condition.
  • Room and board, unless your hospice provider decides that you require respite or short-term inpatient care services and make the arrangements for it. Medicare will cover your stay, but you may be charged a small copayment in case of respite care.

How Long Does Medicare Provide Hospice Care?

Medicare covers hospice care for up to six months (less if the terminal condition results in its natural outcome).

But what happens if the person lives longer than the hospice benefit covers?

Well, if the patient lives beyond six months, they can renew their hospice care as long as a hospice medical director recertifies their illness as terminal. You don’t have to “reselect” hospice care providers every time.

The duration of hospice care consists of two 90-day periods. After that, you can get an unlimited number of 60-day care periods.

On the first day of the first 90-day hospice care period, your regular or hospice doctor must officially state that you’re terminally sick.

Where Does a Person Receive Medicare-Covered Hospice Care?

Medicare-covered hospice care is available from the comfort of the patient’s private residence.

Most cases receive hospice benefits at home, but it’s also possible to get hospice care in an inpatient facility such as a nursing home, memory care, or assisted living, or hospice inpatient facility.

Your hospice provider will make the necessary arrangements for you to stay in an inpatient facility if they decide you need it at any point during your hospice care.

How Does Stopping Hospice Care Work?

If your illness goes into remission or your health improves, you won’t need to stay in hospice care. You can choose to stop hospice care then.

Even if you don’t get better but decide to pursue curative treatment instead of comfort care, you always have the right at any time to end hospice care.

In any case, your hospice provider will ask you to sign a form confirming the date you’ll exit hospice care.

Medicare and Hospice Coverage

So, does Medicare cover hospice care?

The answer is yes. Medicare will provide coverage for nearly all facets of hospice care as long as you’re eligible to receive it.

To qualify for Medicare hospice care, you must be signed up for Medicare Part A, your doctor(s) must verify that you’re terminally ill, and you must confirm that you’re looking for comfort care, not seeking treatment to cure your terminal condition.

Most patients receive hospice benefits at home, but hospice care can also be provided in an inpatient hospice facility, nursing home, memory care, or assisted living community.

An expert in senior care, Amie has professional and personal experience in senior housing, caregiving, end-of-life care, and more from her 24 years of working with older adults.