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Does Medicare cover hospice care?

Yes, Medicare’s hospice care benefits cover a wide range of services — medical, social, emotional and spiritual — to provide as much comfort as possible to terminally ill people and their caregivers in the last days or months of life.

The focus of hospice care is to provide comfort care, more formally known as palliative care, rather than medical treatment to cure your illness. You can receive Medicare-certified hospice care in your home, at an inpatient hospice center or at a nursing home or other facility. Medicare Part A covers hospice care.

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Who is eligible for Medicare’s hospice benefits?

To qualify for Medicare’s hospice benefit, you must meet the following conditions:

  • Comfort care only. You sign a statement choosing to receive hospice care instead of other Medicare-covered treatments intended to cure your terminal illness.
  • Death expected soon. Your hospice doctor and your regular doctor, if you have one, certify that you are terminally ill and have a life expectancy of six months or less.
  • Program authorized. You enroll in a hospice program that Medicare has approved.
  • Part A in place. You have Medicare Part A hospital insurance.

You can get hospice care for up to two 90-day periods, followed by an unlimited number of 60-day periods. At the start of each period of care, your hospice doctor needs to confirm your terminally ill status for you to continue receiving hospice care benefits.

What do Medicare’s hospice benefits cover?

If you qualify and choose to receive hospice care, the benefits should cover everything you need related to your terminal illness with very little cost to you. Your hospice team creates a care plan that may include the following covered services:

  • Doctor services and nursing care.
  • Drugs to help control your pain.
  • Health aide and homemaker services.
  • Medical equipment and supplies.
  • Physical therapy, occupational therapy and speech and language pathology services.
  • Short-term inpatient care in a Medicare-approved facility, such as a hospice facility, hospital or skilled nursing facility, for pain and symptom management. This also covers inpatient respite care to give your caregiver a break. You can get occasional respite care for up to five days each time.
  • Social work services and dietary counseling.
  • Spiritual and grief counseling for you and your family.
  • Support for your caregiver(s).
  • Other Medicare-covered services that your hospice team recommends to manage your terminal illness and related conditions.

What are the costs for hospice care under Medicare?

Medicare Part A covers most hospice services in full, but you may have the following out-of-pocket costs:

  • A maximum of $5 per prescription for drugs used to control the symptoms and pain of your terminal illness.
  • Up to 5 percent of the cost of inpatient respite care.
  • Room and board if you live in a facility that is not for hospice care, such as a nursing home, but where you choose to receive hospice care.

Keep in mind

You are free to end hospice care any time you want — then resume it if that’s your wish. Medicare’s hospice coverage continues as long as your doctor and a hospice doctor certify that you’re terminally ill, even if you live longer than six months.

You can use Medicare benefits to get care for health problems that aren’t a part of your terminal illness, paying for any of Medicare’s copayments and deductibles as usual. But once you choose hospice care, you can’t use your Medicare benefits to cure your terminal illness.

Original Medicare will cover your hospice benefits, even if you’ve chosen a Medicare Advantage plan. If you had a Medicare Advantage plan before you started hospice care, you can choose to stay in that plan if you pay the monthly premiums. The plan can cover care not related to your terminal illness.

Beware of hospice fraud, when scammers enroll Medicare beneficiaries who aren’t terminally ill in hospice without their knowledge. The criminals receive payment from Medicare for the hospice services never delivered, leaving the Medicare beneficiary who files legitimate claims, not for hospice, denied.

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