Whether deciding for yourself or a loved one who is terminally ill, hospice care can be an essential option that may help provide the necessary care to enhance the quality of life towards the end of life for those experiencing a life-limiting illness.
For those having to go through this decision, clarity on hospice care costs and how you can pay for it is an important question to answer. Here are details on how Medicare handles hospice care.
What is Hospice Care?
A hospice takes care of terminally ill patients, defined as those with a life expectancy of 6 months or less. Hospice care’s objective is to reduce pain and manage symptoms rather than cure illness and focus on the patient’s emotional, social, and spiritual needs as they face their end of life. Patients receive Medicare-certified hospice care in their home or another facility where they live, such as a nursing home.
If you are above 65 and covered by Medicare, you may wonder – how exactly does Medicare cover hospice care?
Does Original Medicare Cover Hospice Care?
For Medicare to cover your hospice care costs:
- You must be eligible for Medicare Part A
- Both a hospice medical director and your doctor must certify that you are terminally ill (meaning a life expectancy of 6 months or less); and
- You are required to sign a statement stating your decision to pursue palliative care and receive hospice care instead of using Medicare benefits to treat your terminal illness.
Here is a summary of what hospice care services Medicare covers:
- All services and items needed for pain relief and symptom management
- Medical, nursing, and social services
- Prescription drugs, but only for pain relief and symptom control
- Durable medical equipment (DME) for pain relief and symptom management
- Aide and homemaker services
- Grief and loss counseling for the beneficiary and your family
- Short-term inpatient respite care for your caregivers, which covers the beneficiaries stay in hospitals and other Medicare-approved facilities to enable your caregiver to rest
While Medicare covers most hospice care costs, you will be required to contribute small copayments for prescription drugs for pain and symptom relief ($5 in 2021) and inpatient respite care in an approved facility (5% in 2021).
Does Medicare Advantage cover Hospice Care?
Traditionally, even if you have a Medicare Advantage Plan, your hospice care benefits are still delivered through Original Medicare once a patient elects hospice.
Beginning 2021, CMS will pilot-testing a program that includes hospice benefits under Medicare Advantage. However, participation is optional, and there are no requirements for Medicare Advantage plans to provide hospice care.
Does Medicare Supplement (Medigap) Cover Hospice Care?
Original Medicare already covers most costs related to hospice care. However, if you have a Medicare Supplement plan and continue paying premiums while under hospice care, your remaining out-of-pocket expenses (related to your hospice care) are covered, such as the 5% copayment for respite care. Medigap plans will also continue to cover out-of-pocket costs for conditions unrelated to your terminal illness.
Does Medicare Part D Cover Hospice Care Drugs?
In general, Original Medicare will cover all the prescription drugs to reduce your pain or manage the symptoms of your illness with a small copayment.
However, if you have prescription drugs (not intended to treat your illness), your Medicare Part D plan will help cover your drug costs. If the hospice does not cover some drugs, the hospice provider may also check if your Medicare Part D plan covers it.
Does Medicare Cover Hospice Care If You Live Beyond The Initial 6 Months Life Expectancy?
Yes, you will continue to receive hospice care as long as the hospice medical director or your doctor recertifies your terminal illness.
What are Services are not Covered By Original Medicare?
Medicare will not cover these costs once you elect to receive hospice care:
- Treatments designed to cure your terminal illness and/or its related conditions
- Prescription drugs that cure your illness. Only drugs to control the symptoms or relieve pain are allowable.
- Care from a hospice provider that your hospice medical team did not arrange
- Room and board, whether you receive hospice care in your own home, nursing homes, or a hospice inpatient facility. However, if the hospice team decides that short-term inpatient or respite care is necessary for your caregiver, Medicare will cover the stay.
- Care in hospitals (outpatient or inpatient) and ambulance transport for reasons unrelated to your terminal illness. The only exception is if the hospice team arranged this.
If you or a loved one is considering hospice care, you rest assured that Medicare will generally cover most of the costs for hospice, except for small copayments for prescription drugs and respite care. To receive Medicare coverage, you must first be certified as terminally ill by a hospice medical director and your doctor and elect to receive palliative care instead of pursuing treatment for your illness with Medicare benefits.