Medicare will cover the costs of hospice care when a person with a terminal illness is ready. Medicare hospice coverage includes two 90-day periods and then an unlimited number of subsequent 60-day periods.
Original Medicare, which includes parts A and B, and Medicare Advantage, also known as Part C, provide hospice care coverage. Part D can provide coverage for certain medications a person may require.
A person can still get coverage for conditions unrelated to their terminal illness, but they will no longer get coverage for curative care for it.
Medicare will cover hospice care in small increments. Initially, qualified people will receive two 90-day periods of coverage.
If they go over the two periods, they can receive unlimited 60-day coverage periods. A person can change their hospice provider once per benefit period.
In other words, once someone decides to start hospice care with their medical team, they will continually get approval for short durations until they no longer need care.
To qualify for hospice care, a person must meet the following three criteria:
- A hospice doctor and primary care doctor — if a person has one — must certify that a person is terminally ill with a life expectancy of 6 months or less.
- A person accepts comfort care, known as palliative care, instead of curative care for the illness.
- A person signs a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions.
A person’s situation and desire for hospice care can vary greatly and is an individual decision. Individuals need to discuss the potential for hospice care with a primary doctor to determine if switching to palliative care is the best option for them.
A person can receive hospice care with Medicare coverage through any approved provider. Services may occur at home, in a nursing home facility, or inpatient hospice facility.
If a person chooses inpatient care, they must arrange their stay through their hospice care team. If they do not, they may be responsible for the full cost of inpatient hospice care.
A person can discuss their desires with healthcare professionals, family, and friends to determine when and where the best time to start hospice care is.
Generally, hospice care will include items and services to reduce pain or disease severity and manage a person’s condition. This may include:
- nursing care
- medical equipment
- medical supplies
- drugs
- hospice aid and homemaker services
- physical and occupational therapy
- dietary counseling
- family grief and loss counseling
Medicare may also cover other reasonable and necessary services within a person’s plan of care. However, the hospice program must offer and arrange these services.
Costs relating to hospice care through Medicare are generally low. A person will pay nothing for hospice care as long as they receive services through a Medicare-approved hospice provider.
However, a person may still need to cover their monthly premium for Medicare or Medicare Advantage plans.
Medicare Part D will cover the cost of medications, though a person may need to pay a copayment of up to $5.
For inpatient respite care, a person may need to pay up to 5% of the Medicare-approved amount for the care. This amount cannot exceed the inpatient hospital deductible for the year.
If a person chooses to stay in a nursing home, they may still need to pay for room and board.
Medicare will also continue to cover medications or services for approved medical conditions not relating to hospice, but a person will still need to pay any copays or deductibles.
Medicare will also stop providing coverage for curative treatments for the terminal illness once hospice care starts.
If a person does not have Medicare, they may still be able to get free or reduced-cost hospice care. Hospice providers often provide free or reduced-cost coverage based on financial need to underinsured or uninsured people. They can often do this using donations, grants, and other sources.
Medicare covers hospice care in the home, nursing home, or inpatient stays at the hospital. Once a person has approval, Medicare should cover the full cost, minus medication copays and possible coinsurance payments for inpatient care. A person can only receive care in Medicare-approved facilities or providers.
Once hospice starts, Medicare may continue to cover other treatments and medications not related to the terminal illness, but it will no longer cover curative treatments.
A person should discuss hospice care with a doctor or other qualified healthcare professional. They can help the person obtain approval and determine if hospice care is the best option.