Does Medicare Cover Hospice Care?
February 2, 2024 | John Demko
Original Medicare covers many medically necessary medical services that one would need; however, at the same time, Medicare doesn’t cover everything, and seniors may find themselves paying out of pocket or obtaining additional medical insurance to cover certain services. It can be challenging to understand your health coverage. When you or a loved one is dealing with a serious illness or navigating the end of life, the last thing you want to spend time doing is dealing with understanding health insurance.
So what about hospice care? If you find yourself or a loved one in need of hospice care, can you count on Medicare to cover the care and expense of hospice? We’ll share everything you need to know in this article, offering clarity when you need it most.
What is Hospice Care?
As described by the National Institute of Aging (NIA), at a certain stage, curing a severe illness may not be possible, or a patient might opt out of specific treatments. In such cases, hospice care is provided for individuals with a terminal illness, where their doctor estimates six months or less to live if the disease follows its natural course.
Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness approaching the end of life.
How Does Medicare Cover Hospice Care?
If it is determined that an individual meets the criteria for needing hospice care, then care will be covered by original Medicare part A. However, Medicare will only cover hospice care if the hospice provider is Medicare-approved. To find out if a particular hospice provider is Medicare-approved, you can inquire with the hospice provider directly, your doctor or your state hospice organization. If you’re in a Medicare Advantage Plan (like an HMO or PPO) and want to start hospice care, ask your plan to help find a hospice provider in your area. Your plan must help you locate a Medicare-approved hospice provider in your area.
If you qualify for hospice care, you and your family will work with your hospice team to set up a plan of care that meets your needs. For more specific information on a hospice plan of care, call your national or state hospice organization.
Your Hospice Costs with Original Medicare
- You pay nothing for hospice care.
- You pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn’t cover your drug, your hospice provider should contact your plan to see if Part D covers it. The hospice provider will inform you if any drugs or services aren’t covered, and if you’ll be required to pay for them.
- You may pay 5% of the Medicare-approved amount for inpatient respite care. Your copay can’t exceed the inpatient hospital deductible for the year.
- Original Medicare will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions, but this is unusual. Once you choose hospice care, your hospice benefit will usually cover everything you need.
- You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care.
Source: Medicare.gov
As described by Medicare.gov, based on your terminal illness and related conditions, your hospice team will craft a care plan, encompassing various services:
- Doctors’ services
- Nursing and medical support
- Durable medical equipment for pain relief
- Medical supplies such as bandages or catheters
- Medications for pain and symptom management
- Aide and homemaker assistance
- Physical, occupational, and speech-language therapy
- Social services
- Dietary counseling
- Spiritual and grief counseling for you and your family
- Short-term inpatient care for symptom management
- Inpatient respite care in a Medicare-approved facility, offering your caregiver a rest period. You can enjoy up to 5 days each time you receive respite care, occasionally and as arranged by your hospice provider.
- Any other Medicare-covered services recommended by your hospice team to manage pain and symptoms related to your terminal illness and associated conditions.
If you or a loved one needs help understanding Medicare coverage options and what is covered by Medicare, the trusted team of Medicare agents at Twin City Underwriters can help. Reach out today.
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