Medicare offers a hospice benefit to plan holders with a terminal health condition. This benefit allows an individual to receive palliative, quality end-of-life care.
Hospice care provides support and care for people approaching the end of their lives, as well as support for their families.
A hospice program changes the focus of treatment. Healthcare professionals no longer actively work to resolve a person’s medical condition. Instead, they focus on providing comfort and supportive care to a person nearing the end of their life.
Keep reading for more information on what Medicare covers for hospice care, the costs, and how long a person can expect coverage.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Hospice coverage can vary according to a person’s unique situation. The key aspect is that hospice care represents a shift from curative to comfort-oriented treatments.
As a result, once a person triggers their hospice benefit, Medicare may no longer pay for doctor’s visits or medications that aim to treat the condition.
To receive hospice care benefits from Medicare, a person must meet the following criteria:
- A medical doctor and hospice doctor must certify that a person is terminally ill and likely to live for fewer than 6 months.
- A person must accept palliative care to provide comfort instead of care that aims to cure or treat their illness.
- The insured person must sign a statement indicating their desire to receive hospice care instead of other Medicare-covered treatments for their condition.
Here’s how Medicare covers hospice care, according to the Centers for Medicare & Medicaid Services:
- With original Medicare (Part A and Part B), Part A covers the cost of hospice.
- Medicare Part D may cover the cost of medications if Part A denies coverage for any reason.
- A Medicare Advantage (Part C) plan may cover the cost of any additional comfort or support medications or treatment that Part A does not already cover.
- Medigap may help cover the cost of deductibles or other noncovered costs, but it does not specifically cover long-term care costs.
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare will directly pay the healthcare professionals providing a person’s hospice care. When a person enters a hospice program, they do not have to meet a deductible for hospice care.
However, some associated costs apply. These include:
- monthly premiums for Medicare parts A (if applicable) and B
- a copayment of up to $5 for prescription pain medications or other medications to manage discomfort
- a 5% coinsurance of the Medicare-approved amount for inpatient respite care
If a person’s condition means that they need hospital treatment while in hospice care, a hospice organization must make the arrangements. This is vital, as the healthcare professionals providing the hospice care will pay the hospital directly.
A person can activate hospice care when they have a life expectancy of fewer than 6 months. If they live longer than this, a person’s doctor can re-certify that they are terminally ill and need continued care.
According to a study in the Journal of Gerontology, the mean Medicare hospice stay is 86 days.
A person also has the right to stop hospice care at any time if they wish to do so.
Hospice care can significantly reduce hospital stays and trips to the emergency room that a person may otherwise experience as they approach the end of their life.
Medicare pays for this benefit to provide as much comfort and peace as possible to people with terminal health conditions as they near the end of their life.
Once coverage for hospice care begins, coverage for standard treatment no longer applies.