What does the hospice benefit not cover?
When considering hospice care, bear in mind that Medicare will not cover:
The cost of treatment (including prescription drugs) intended to cure your terminal illness. You cannot have the hospice benefit and also use your regular Medicare coverage to pay for this treatment. But Medicare will still cover the costs of treating other medical conditions (including hospital stays) not connected to your terminal illness.
Room and board. Typically, hospice care is provided to people living in their own homes. It’s also available to those who live in nursing homes or a hospice residential facility, but Medicare does not pay anything toward the costs of room and board. The exception is short-term inpatient and respite care, as noted above.
What does hospice care cost?
Medicare pays the hospice program a daily fee that covers almost all of your costs. You pay the following:
No more than $5 per prescription for each medication used to control symptoms and provide pain relief for your terminal illness.
A copayment for inpatient respite care, amounting to 5 percent of the Medicare-approved daily rate. (For example, if Medicare pays $200 a day, your share would be $10 a day.)
Is the decision to receive hospice care irrevocable?
No. You can change your mind and stop hospice care for any reason at any time. Similarly, if you stop hospice care and later want to return to it, you can do that, too. When not receiving hospice care, you will have the same kind of Medicare coverage that you had before.
How long can you get Medicare coverage for hospice care?
The Medicare hospice benefit continues as long your doctor and a hospice doctor continue to certify that you are terminally ill, even if you live longer than six months. If your health improves and the doctors decide you no longer need hospice care, the benefit ends—although if you don’t agree with their decision, you have the right to appeal it. If your health deteriorates again, and the doctors recertify that your illness is terminal, the benefit can begin again.
What if you are in a Medicare Advantage health plan or have medigap insurance?
Hospice care is covered regardless of whether you’re enrolled in a Medicare health plan (such as an HMO or PPO) or in the traditional Medicare program. If you have private medigap supplemental insurance, it will still cover health care costs that are not related to your terminal illness, depending on the terms of your policy.
For more information on hospice care and how to find a Medicare-approved hospice program, go to:
“Medicare Hospice Benefits” (Medicare publication).
Patricia Barry is a senior editor at the AARP Bulletin.