Hospice care is patient-centered care for people near end of life. If you or a loved one are in need of hospice care, Medicare Part A provides a hospice benefit that can cover most of the costs. However, as you begin to evaluate care options, it’s important to understand who’s eligible for hospice care and what services are covered.
Our guide to Medicare hospice benefits includes information on the four types of hospice care, what Medicare covers and possible out-of-pocket costs. Read on to learn more.
Table of Contents
- What is hospice care?
- Who qualifies for hospice care?
- Levels of hospice care
- Does Medicare pay for hospice?
- How long will Medicare pay for hospice care?
- Does Medicare Pay for Hospice? FAQs
- Summary of Money’s Does Medicare Pay for Hospice Care?
What is hospice care?
Hospice care, sometimes referred to as “comfort care,” is a program of care and support for people who are terminally ill and their families. Someone who receives hospice care has a life expectancy of six months or less, if the illness runs its normal course.
Hospice care services are focused on comfort, so the person will receive physical care, counseling, equipment and drugs for the terminal illness and related conditions. However, treatments to cure the illness are not part of hospice care.
Anyone who has Medicare coverage or a Medicare Advantage Plan is eligible to receive the benefit through Original Medicare. For those who are insured by Medicaid, hospice care benefits vary by state. Many private insurance companies also provide hospice care.
Who qualifies for hospice care?
To qualify for hospice care, a person must receive certification from a physician (usually their primary care doctor or a specialist) as well as a hospice physician. However, even without a physician’s recommendation, the person’s caregiver can request care from a local hospice program provider.
The person who receives hospice care may:
- Be diagnosed with a terminal illness or advanced stages of Alzheimer’s or dementia
- Have a prognosis of six months or less to live, according to physicians
- Be experiencing a significant decline in health (physical and/or mental) despite medical treatment
Some of the most common diagnoses of people in hospice care include cancer, cardiovascular disease, debilitating strokes, amyotrophic lateral sclerosis (ALS), age-related dementia and AIDS.
Levels of hospice care
There are four levels of hospice care as defined by Medicare.
|Patient is…||Care is provided…|
|Routine home care||Stable with symptoms, such as pain or vomiting, that can be controlled||In home|
|Continuous home care||At crisis-level with out-of-control pain and symptoms, and requires short-term management||In home|
|General inpatient care||At crisis-level with out-of-control pain and symptoms, and requires short-term management||At a medical facility such as a hospital or skilled nursing facility|
|Respite care||In need of full-time care||In a senior care facility, nursing home, hospice inpatient facility or hospital|
Does Medicare pay for hospice?
Medicare pays for hospice care under Part A (hospital insurance) of Original Medicare. Even if you have a Medicare Advantage Plan (Part C) through a private company, you are still eligible for coverage. The Medicare hospice benefit includes care for up to two 90-day periods, and an unlimited number of 60-day periods thereafter.
To qualify, the person receiving care must have a life expectancy of six months or less as certified by a doctor as well as a hospice doctor. The caregiver must also sign a statement choosing hospice over alternative, Medicare-covered treatments that aim to cure the terminal illness in question. Additionally, for the participant to qualify for coverage, the care providers must be Medicare-approved.
Hospice care covered by Medicare
The Medicare hospice benefit covers care costs up to a specified limit and for set periods. To qualify, you must use Medicare-approved hospice providers for home care. If you elect to use a hospice facility, it must also be approved by Medicare.
Below you’ll find details on Medicare-covered services by type of hospice care.
|Medicare hospice coverage||Cost covered||Days covered|
|Routine home care||Up to $207 per day||1 to 60|
|Routine home care||Up to $163 per day||Day 61 and after|
|Continuous home care||Up to $1,492 per day||Periods of patient crisis for eight to 24 hours per day|
|General inpatient care||Up to $1,068 per day||Periods of patient crisis for eight to 24 hours per day|
|Inpatient respite care for caregivers||Up to $473 per day||Short period for respite of caregiver|
Hospice care covered by Medicare is typically coordinated by a hospice care team of Medicare-approved providers, which can include doctors, pharmacists, nurses, nurse practitioners, hospice aides and counselors.
Depending on the terminal illness and related conditions, the care plan can include any or all of these services:
- Doctor services
- Skilled nursing care
- Short-term inpatient care for pain/symptom management
- Short-term respite care for caregivers
- Hospice aide and homemaker services
- Social worker services
- Durable medical equipment (DME) (wheelchairs or walkers)
- Medical supplies (bandages and catheters)
- Prescription drugs for pain and symptom management (possible $5 copay)
- Spiritual or religious counseling for you and your family
- Speech-language pathology services
- Physical and occupational therapy
- Dietary counseling
Hospice care services not covered by Medicare
A person who enters hospice care doesn’t want to continue treatments to cure their illness and related conditions or a doctor has determined that these efforts aren’t working, or both. As such, the Medicare hospice benefit does not cover curative medicine.
Hospice care services not covered by Medicare include:
- Curative methods, such as treatments and prescription medications intended to cure the illness
- Room and board outside of Medicare-certified hospice facilities, such as a hospital or a nursing facility
- Emergency care, such as ambulance fees and emergency room visits, unless arranged by your hospice medical team
- Inpatient and outpatient hospital visits, unless arranged by your hospice medical team or hospice medical director
Note that while these services aren’t covered by Medicare benefits, some services associated with the illness or related conditions may still be covered under Medicare Part A, Medicare Part B or Medicare Advantage.
Additionally, prescription drugs not covered through the hospice benefit may be covered by Medicare (Part D). Contact your hospice team before you get any of these services to avoid paying the full cost.
How long will Medicare pay for hospice care?
Medicare will pay for hospice care as long as the patient meets eligibility requirements. Should the patient live longer than the initial six-month diagnosis, Medicare covers hospice care for two 90-day periods and an unlimited number of 60-day periods. Before each period, the patient must be evaluated to ensure they’re eligible.
What you pay for hospice care
In addition to your Medicare premium, there are some out-of-pocket costs associated with hospice care. Some of these costs include:
- A copay of up to $5 for medications related to symptom and pain relief
- Room and board in facilities that are not Medicare-approved hospice care centers
- Emergency care (hospital visits, ambulances) not arranged by the hospice team
- 5% of Medicare-approved cost of respite care for caregivers
- Alternatives to pay for hospice care
If you aren’t covered by Medicare, there are other ways to pay for hospice care, such as private insurance or supplemental insurance plans. Here are some of your options:
Private insurance - Your private insurance plan may include hospice-related benefits. Speak with an insurance representative to find out what’s covered.
VA benefits - If you’re a veteran and are enrolled in the VA Standard Medical Benefits Package, hospice care — in home or at a nursing home or assisted living facility — is covered. in addition Other related services, such as occupational therapy or grief counseling, are also covered.
Long-term care insurance - Some plans cover hospice-related services, such as in-home nursing and palliative care. Coverage varies by plan and provider, so be sure to check your plan documents or consult with an insurance expert before choosing a plan.
Hospital indemnity insurance - With this type of supplemental insurance plan, the insurer pays the policyholder a set amount per day during hospital stays. These funds can be used for any purpose.
Specified disease insurance - Insurance companies offer coverage for specific diseases, such as cancer or end-stage renal failure. Benefits cover costs such as treatment or hospital stays.
Crowdfunding - You can look to your network of friends and family to help raise funds for necessary care.
Does Medicare Pay for Hospice? FAQs
Does Medicare cover hospice care?
Does Medicare pay for hospice care in a skilled nursing facility?
Is hospice covered by Medicare Part A or B?
Do Medicare Advantage plans cover hospice?
How much does Medicare pay for hospice per day?
How much Medicare pays for hospice per day varies by type of hospice care. For example, Medicare covers up to $207 per day for routine home care for days one through 60 and $163 per day thereafter. During periods of crisis, Medicare covers up to $1,492 per day for continuous home care and $1,068 for general inpatient hospice care.
Inpatient respite care for primary caregivers, such as family members or loved ones, is covered up to $473 per day, but you may have to pay a deductible or coinsurance cost of 5% of the Medicare-approved amount.
To create our guide to Medicare hospice care, we first determined the most commonly asked questions about this type of health care to provide the most comprehensive information possible.
We then researched and analyzed information available through reputable sources online, including:
- U.S. Medicare program at Medicare.gov
- The National Institute on Aging
- The National Hospice and Palliative Care Organization
- The American Hospice Foundation
Many hours of research went into completing this guide, which offers help for understanding the costs of the four levels of hospice care, as well as the specifics and duration of the care provided by each, as covered by Medicare.
Summary of Money’s Does Medicare pay for hospice
Hospice care is patient-centered care for people who have a prognosis of six months or less to live as certified by the patient’s regular doctor or other physician, as well as a hospice doctor. They do not receive treatments to cure the illness as part of their plan of care, but hospice patients do receive pain and symptom relief. Care may be provided at home, a hospice facility, a skilled nursing facility or in a hospital.
Medicare hospice care coverage is available for people who have Medicare Part A (Hospital Insurance). All four levels of hospice care are covered under the Medicare hospice benefit, although coverage amounts vary by type of care. However, there are some aspects of hospice care, such as prescription medications and certain home medications, that require a copay or are not covered at all.
For more information about Medicare's coverage of hospice care, visit Medicare.gov or call 1-800-MEDICARE.