Medicare and Hospice Care

If a doctor ever diagnoses you or a loved one with an incurable disease with six months or less to live, you might want to take advantage of hospice care.

Hospice provides all the physical, emotional, and even spiritual support you might need. And Medicare pays for almost all the hospice care you receive – if you meet certain conditions.

What requirements do you need to meet for Medicare to cover hospice care? And what kind of Medicare plan do you need to have to benefit from this coverage?

You’ll find answers to both of those questions in this article. And you’ll find answers to these questions here, too:

• How do the different types of Medicare cover hospice care?
• Are there any aspects of hospice care that Medicare doesn’t cover?
• How long does Medicare pay for or cover hospice care?
• Where can you receive hospice care with Medicare?
• Can you get hospice care from any provider you choose with Medicare?
• Do Medicare Advantage plans cover hospice care?
• Does Medicare Supplement insurance cover hospice care?
• How much does hospice care cost if Medicare won’t pay for it?
• What can you do if Medicare won’t cover the hospice care you need?

How Do Different Types of Medicare Cover Hospice Care?

As suggested earlier, terminally ill people who have Medicare should be eligible for hospice care. And not only that, but they should pay very little, and possibly nothing at all, out of pocket for it.

Most people think you need to have cancer to qualify for this kind of supportive care. That’s not true.

Although it’s true that most hospice patients had cancer when hospice was first introduced to the US, today many of them have other illnesses and conditions.

For example, some people with late-stage heart, lung, or kidney disease now benefit from this kind of care, according to the Hospice Foundation of America. It often benefits people with advanced Alzheimer's disease or dementia, too.

The Centers for Medicare & Medicaid Services (CMS) seemingly pays no mind to an enrollee’s condition, disease, or illness when determining if they’re eligible for hospice coverage.

What does CMS consider in this situation? First, you must have Medicare Part A. You may know Part A as “hospital insurance.” (As opposed to Part B, which many call “medical insurance.”)

Part A covers a lot of types of care. It covers most of the care you receive in a hospital, of course (hence its nickname). But it also covers most of the care you receive in a skilled nursing facility – as long as you’re not there too long. And it covers some home health services.

What’s important here, though, is Part A covers hospice care. And it covers it pretty fully, too. Some of the hospice components this Medicare “part” covers are:

• Nursing care
• Medical equipment and supplies (like wheelchairs, walkers, and even catheters or bandages)
• Prescription drugs for symptom control or pain relief
• Any other Medicare-covered services needed to manage your pain or control symptoms related to your terminal illness
• Physical and occupational therapy
• Speech-language pathology services
• Social work services
• Dietary counseling
• Grief and loss counseling (for you and your family)
• Short-term inpatient care for pain and symptom management

Medicare Part A also covers short-term respite care. What that means: if a family-member caregiver needs a break, has to travel, or otherwise can’t take care of you for a short period of time, your Part A coverage will pay for you to receive care in a “Medicare-approved facility” for up to five days at a time.

A Medicare-approved facility in this case could be an inpatient hospice facility, by the way. Or it could be a hospital or nursing home.

When does Part A pay for the hospice care listed above? Or under what circumstances does it pay for it? Here are the conditions medicare.gov says you must meet to qualify for this coverage:

• Your regular primary care physician and your hospice doctor certify you’re terminally ill and you have a life expectancy of six months or less.
• You agree to stop treating or trying to cure your terminal illness. And you agree to receive supportive or palliative care instead.
• You sign a statement that makes it clear you’re choosing hospice care over care that’ll treat or attempt to cure your terminal illness (or other related conditions).

Although Medicare won’t pay to treat your terminal illness after you start hospice care, it will pay to treat conditions not related to that illness. (Or at least it’ll pay for them if Part A or Part B usually covers those treatments and services.)

If that happens, though, you’ll have to pay the deductible and coinsurance amounts tied to that care.

By the way, Medicare will cover your hospice care for longer than six months, if needed. Your hospice doctor just has to recertify that you’re terminally ill for the coverage to continue.

As for Medicare Part B and Part D, they only come into play in this situation if:

• You have a condition unrelated to your terminal illness that requires treatment.
• The Medicare hospice benefit won’t cover one or more of the drugs you need. Your Part D plan (if you have one) may pay for the medication in that case.

Want to learn more about Parts A, B, C, and D? Read through our Medicare guide. And check out our Medicare Part D article, too.

Are There Any Aspects of Hospice Care That Medicare Doesn’t Cover?

As you just learned, Medicare Part A does a pretty good job of covering hospice care. It doesn’t cover every single aspect of this kind of care, however.

A few examples of the aspects Medicare won’t pay for after your hospice benefit begins:

• Any care you receive that wasn’t given or arranged by your hospice team. If you want a different hospice to treat you, you must change providers. Medicare only lets you change hospice providers once during each benefit period.
• Your room and board. In other words, Medicare won’t pay your rent or your mortgage if you get hospice care in your home. It also typically won’t pay for you to live in a nursing home or inpatient hospice facility. (Sometimes a hospice team will decide a patient needs short-term inpatient or respite care. Medicare covers those stays, though it might charge you a small copay for them.)
• Some hospital and ambulance costs. If you go to the emergency room, call an ambulance to get there, or receive care as a hospital outpatient, Medicare won’t cover the resulting bills if they’re related to your terminal illness. It will cover them if your hospice team arranged for them, though, or if they’re associated with a different disease or condition.

How Long Does Medicare Cover Hospice Care?

Although your life expectancy must be six months or less for you to qualify for hospice coverage under Medicare, that doesn’t mean Medicare will only pay for six months of this kind of care.

In fact, Medicare will continue to cover your hospice treatment beyond that milestone as long as your hospice doctor certifies you’re still terminally ill.

He or she has to do this every 60 days after the first six-month benefit period ends, according to medicare.gov. Also, they can continue to do this for an unlimited number of 60-day benefit periods.

Where Can You Receive Hospice Care Under Medicare?

Most people with terminal illnesses receive hospice care in their own homes.

Thankfully, the Centers for Medicare & Medicaid Services covers this kind of treatment in that setting.

Medicare also covers hospice care provided at inpatient facilities, too. It only does so if your hospice doctor and team decide you need inpatient care, however.

And in that situation, they’ll arrange for your transfer to one of those facilities.

Can I Get Hospice Care from Any Provider I Choose with Medicare?

If you want your Medicare Part A plan to pay for your hospice care, you have to go to a Medicare-approved hospice provider.

Not sure if a provider you or your loved ones are considering is Medicare-approved? Ask:

• The hospice provider
• Your doctor or physician
• Your state health department
• Your state hospice organization

Do Medicare Advantage Plans Cover Hospice Care?

Yes, they do. Which makes sense, as Medicare Advantage plans basically take the place of Original Medicare. To put it another way: they provide enrollees with their Part A and Part B benefits.

This means, of course, that a Medicare Advantage plan will cover your hospice care at least as well as Original Medicare. And it might do an even better job of covering it than “traditional” Medicare does. For example, it may cover the deductibles, copays, and coinsurance amounts you’re charged while in hospice.

On a related note: Original Medicare covers your hospice treatments and services even if you have a Medicare Advantage plan. As such, you can drop your Medicare Advantage coverage when you switch to hospice care.

Some people to stick with their Medicare Advantage plans in this case, though, because it gives them more options if they need treatments or services not related to their terminal illness.

For more information, read our Medicare Advantage guide.

Does Medicare Supplement Insurance Cover Hospice Care?

Yes, Medicare Supplement, also called MedSup or Medigap, insurance covers hospice care, too. Or at least it does so in a way.

As you may or may not know, MedSup plans pay some of the costs Original Medicare doesn’t. Specifically, they often help cover enrollees’ deductibles, copays, and coinsurance amounts.

If you have a MedSup or Medigap policy, it should cover the copays you’re charged for prescription medications while in hospice care. Or it should cover the 5-percent coinsurance you’re charged for inpatient respite care.

Not all MedSup policies cover these out-of-pocket costs to the same extent, though, so read the fine print of any plan you’re considering if full hospice care coverage is important to you.

To learn more about Medigap or MedSup, check out this article: “When Does it Make Sense to Get a Medicare Supplement Plan?” And for more on the two most popular MedSup plans around, see our articles on Medicare Plan F and Medicare Plan G.

How Much Does Hospice Care Cost if You Have Medicare?

You pay next to nothing out of pocket for hospice care if you have Medicare Part A coverage and meet these conditions:

• Your regular primary care physician and your hospice doctor certify you’re terminally ill and you have a life expectancy of six months or less.
• You agree to stop treating or trying to cure your terminal illness. And you agree to receive supportive or palliative care instead.
• You sign a statement that makes it clear you’re choosing hospice care over care that’ll treat or attempt to cure your terminal illness (or other related conditions).

Here are the only times you might need to pay for hospice care out of your own pocket in this situation:

• If you’re receiving care at home, you may be charged a copayment of no more than $5 for each prescription drug you need to take.
• And you may have to cover the same copay for other similar products used for pain relief or symptom control.
• You also might have to pay 5 percent of the Medicare-approved amount for inpatient respite care.

How Much Does Hospice Care Cost if You Don’t Have Medicare?

Or how much does hospice care cost if you have Medicare but it won’t pay for it?

It’s unlikely you’ll have to pay much, if anything, out of pocket for hospice care even if you’re not enrolled in Medicare. Or if you’re enrolled in Medicare but it won’t cover hospice care for some reason or other.

For example, if you’re not old enough to have Medicare coverage, you’ll probably rely on either private health insurance or Medicaid to pay for your hospice care.

But what if you’re too young to enroll in Medicare, your assets and income are too high to qualify for Medicaid, or you don’t have private health insurance? A hospice provider might care for you free of charge. Or it may give you a discount or bill you on a sliding scale.

Local organizations often help people in this situation, too. Some provide financial assistance to those who don’t have health coverage but need hospice care.

If you do have to pay out of pocket for hospice care, it’s hard to say just how much you’ll pay for it given the above.

The good news here is hospice tends to cost a lot less than the kind of care usually tied to treating serious illnesses. That’s because the focus of hospice care is to make people who are terminally ill comfortable rather than cure their diseases or prolong their lives.

What Can You Do if Medicare Won’t Pay for Hospice Care?

As mentioned in the last section, if you aren’t enrolled in Medicare or if it won’t pay for your hospice care for one reason or another, your best bets for coverage are private health insurance plans or Medicaid.

Many private health insurance plans – like the ones you get through an employer – offer at least some hospice coverage. They don’t always offer the same amount of this coverage, though, so don’t assume yours will, say, cover you as fully as Medicare would in this instance.

Medicaid often pays for hospice care, too. According to US News, though, state programs vary widely in terms of coverage and eligibility requirements. “Some states, such as Texas and Kentucky, mirror Medicare requirements and stipulate that only those with a life expectancy of six months or less are eligible for hospice care,” the publication reports. “Others, like New York, will admit those with a life expectancy as long as a year.”

Also, “like Medicare, Medicaid requires patients to decline further curative treatments. The exception is for those age 21 or younger. They may continue to seek a cure while receiving hospice.”

If neither of the above are options for you, talk with the hospice providers in your area and see if any of them can help. Some will care for you free of charge if you don’t have health insurance coverage and you can’t afford to pay on your own. Others may give you a discount or bill you on a sliding scale.

Something to keep in mind here: very few Americans pay for hospice care entirely out of their own pockets. And very few rely on charities or other forms of financial assistance to pay for it.

In fact, only about 2 percent pay for it by themselves or need financial assistance, according to debt.org. Around 7 percent use private insurance to pay for it. The rest (about 90 percent) rely on Medicare or Medicaid to pay for their hospice treatment.

Other Frequently Asked Questions

Q: How does hospice care help people? Why do people need or use hospice care?

A: People often turn to hospice care when they are in the last phases of incurable disease and have less than six months to live.

Hospice care can help these men and women by relieving their pain and other symptoms (like shortness of breath). It also can help them maintain, and possibly even improve, their quality of life.

Basically, hospice providers no longer try to cure your terminal condition, disease, or illness. Instead, they focus on making and keeping you as comfortable as possible for whatever time you have left.

Q: Is hospice care different from palliative care? If so, how are they different?

A: Anyone who is seriously ill may benefit from palliative care, which some call supportive care.

Hospice care, on the other hand, usually is limited to people who are dying and are no longer seeking to cure a terminal condition, disease, or illness.

Other than that, though, hospice and palliative care are very similar. Both aim to relieve pain and suffering.

The main difference between the two is that people receiving palliative care don’t have to stop treatment that might cure their serious illness, while hospice patients do.

Q: What is respite care? And how is it different from hospice and palliative care?

A: Respite care is for primary caregivers. It lets them take a break or get away without worrying about their loved ones.

The person with the serious or terminal illness or condition might receive respite care in their own home or at an inpatient hospice facility, a skilled nursing facility, or even a hospital.

Also, Medicare (Part A, specifically) covers most of the cost of up to five days in a row of respite care. And it covers it more than once, too.

References:

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