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medicare hospice benefits
Navigating medicare hospice benefits can be confusing. We often hear questions about how to find a hospice program, what services Medicare hospice benefits cover, and who is eligible to receive Medicare benefits for these services.
Eligibility for Medicare Hospice Benefits
You can get Medicare hospice benefits when you meet all of the following conditions:
- You’re eligible for Medicare Part A (Hospital Insurance).
- Your doctor and the hospice medical director certify that you’reterminally ill and have 6 months or less to live if your illness runs its normal course.
- You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness.*
- You get care from a Medicare-approved hospice program.
* Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.
What Medicare Covers
You can get a one-time only hospice consultation with a hospice medical director or hospice doctor to discuss your care options and management of pain and symptoms. You don’t need to choose hospice care to take advantage of this consultation service.
Medicare will cover the hospice care you get for your terminal illness, but it must be from a Medicare-approved hospice program. Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.
Medicare covers the following hospice services for your terminal illness and related conditions:
- Doctor services
- Nursing care
- Medical equipment and supplies
- Drugs for symptom control or pain relief (may need to pay a small copayment)
- Hospice aide and homemaker services
- Physical and occupational therapy
- Speech-language pathology services
- Social worker services
- Dietary counseling
- Grief and loss counseling for you and your family
- Short-term inpatient care (for pain and symptom management)
- Short-term respite care (may need to pay a small copayment)
- Any other Medicare-covered services needed to manage your painand other symptoms, as recommended by your hospice team
What Medicare Won't Cover
When you choose hospice care, Medicare won’t cover any of the following:
- Treatment intended to cure your terminal illness.
You should talk with your doctor if you’re thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time. This includes prescription drugs to cure your illness rather than for symptom control or pain relief. - Care from any hospice provider that wasn’t set up by the hospice medical team.
You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice medical team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. - Room and board.
Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice residential facility. However, if the hospice medical team determines that you need short-term inpatient or respite care services that they arrange, your stay in the facility is covered. You may have to pay a small copayment for the respite stay. - Care in an emergency room, inpatient facility care, or ambulance transportation.
This care will only be covered if it's either arranged by your hospice medical team or is unrelated to your terminal illness.
Contact your medical hospice team before you get any of these services, or you might have to pay the entire cost.
Need more information?
Have more questions? Read more about Medicare patient rights, Medigap policies, respite care, and what you will have to pay for Medicare Hospice benefits by downloading the official Medicare Hospice Benefits Brochure(.pdf), a comprehensive guide to questions about these services.
Patients and family members can also visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048.
National Hospice & Palliative Care Organization (NHPCO)
1700 Diagonal Road, Suite 625
Alexandria, VA 22314
1-800-658-8898
www.nhpco.org
Hospice Association of America
228 7th Street, SE
Washington, DC 20003
1-202-546-4759
www.nahc.org
