Medicare Coverage for Hospice Care

Q. My father is terminally ill, and we are considering hospice care for his remaining weeks or months. I’ve heard that Medicare has a hospice benefit. Can you explain how it works and how much it would cost?

Medicare has covered hospice care since 1983. It’s one of the most generous benefits that Medicare provides—at little cost to terminally ill patients or their caregivers. Patients who select hospice care are offered a full range of medical and support services, most often in their own homes. It also allows them to be cared for temporarily in an inpatient facility, such as a hospital or nursing home, if their regular caregivers need a break.

What is hospice care?

There may come a time when a treatment intended to cure a serious illness stops working effectively or is more than the patient can bear. Hospice care offers an alternative in the last days or months of life. It focuses not on trying to cure the disease but on providing as much comfort as possible—medical, social, emotional and spiritual—during the time left.

Who is eligible for the Medicare hospice benefit?

To qualify, you must meet all of these conditions:

• You must choose to receive hospice care and give up treatments intended to cure your terminal illness;

• Your doctor and the medical director of a hospice program must certify that you probably have less than six months to live, according to their best clinical judgment;

• You must have Medicare Part A hospital insurance;

• You must enroll in a hospice program that Medicare has approved.

What does the hospice benefit cover?

Medicare covers a one-time consultation with a hospice doctor or medical director to discuss your options for care under the hospice benefit. Medicare pays for this consultation whether or not you ultimately choose hospice care. If you decide to go ahead, it will cover the costs of a trained team of medical and support staff to help you and your family, including the following:

• Doctor services and nursing care, plus round-the-clock, on-call support.

• Medical equipment and supplies.

• Medications to control symptoms and pain.

• Homemaker and home health aide services.

• Physical, occupational or speech therapy.

• Social worker services and dietary counseling.

• Short-term care in a hospital or other facility for medical reasons, as recommended and arranged by your hospice team.

• Short-term respite care in a hospital, nursing home or other type of long-term care facility for up to five days at a time if your caregiver needs a rest.

• Support for your caregiver and family members and, if requested, coaching on how best to help meet your needs.

• Grief and loss counseling for you and your family.