Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Hospice is a comprehensive approach to care that focuses on comfort and quality of life for a person with a serious illness facing the end of life. Hospice care extends support and counsel to loved ones and can be provided in homes or facilities.
All Medicare beneficiaries are eligible for the Medicare Hospice Benefit as long as a physician certifies a terminal condition which will most likely end in death in six months or less if the illness runs its natural course.
Hospice care under Medicare is regulated by the Centers for Medicare and Medicaid Services (CMS) and is provided by Medicare-certified hospice agencies. Read on to learn what hospice covers, how much it costs, and how to access the Medicare Hospice Benefit.
Which Medicare Plans Cover Hospice Care?
Hospice care is covered under Original Medicare Part A. Whether you are enrolled in Original Medicare, a Medicare Advantage Plan, or other Medicare health plan, you can receive hospice benefits. Original Medicare will cover hospice services even if you choose to remain in a Medicare Advantage Plan or other Medicare health plan.
If you have Medicare, it will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions, but hospice should cover most of your care.
A small percentage of Medicare Advantage Plans participate in a Centers for Medicare and Medicaid Services (CMS) demonstration project to provide a hospice benefit through a value-based insurance design. This demonstration project will continue through 2024 and may show that quality, cost-effective hospice care can be covered as a benefit with Medicare Advantage Plans as an alternative to Part A.
What Hospice Care Does Medicare Cover?
Hospice care from a Medicare-approved agency is usually delivered in your home or other facility where you live, such as a nursing home or assisted living facility. About half of all hospice care in the U.S. is provided in private residences. According to the National Hospice and Palliative Care Organization (NHPCO), all Medicare-certified hospices must provide four different levels of care.
|Routine Home Care (RHC)
|About 98% of hospice recipients get this level of care, including intermittent services, such as nursing, social worker, volunteer, chaplain, or nurse aide visits. If you are in your own home, your loved ones serve as your primary care providers. If you live in a facility, your primary care is provided by the facility staff. Hospice provides 24/7 on-call support.
|Continuous Home Care (CHC)
|A very small percentage, around 0.2%, of hospice recipients, get this level of care provided by hospice nursing staff in your place of residence for a short time to help manage difficult symptoms.
|Inpatient Respite Care (IRC)
|A small percentage, around 0.3%, of hospice recipients, get this level of care. The hospice patient is transferred to a facility for up to five days to give a break (respite) to caregivers in the home.
|General Inpatient Level of Care (GIP)
|Around 1% of hospice recipients qualify for this level of care provided in a hospital or inpatient hospice facility. GIP is 24/7 care provided by a specially trained hospice team for patients whose symptoms cannot be well managed in their place of residence. If you need to get inpatient care at a hospital, your hospice provider must make the arrangements. Your inpatient hospital care cost is covered by your hospice benefit but paid to your hospice provider. They have a contract with the hospital, and they work out the payment between them.
When hospice care starts, you, your loved ones, and your hospice team will develop a plan of care based on your terminal condition and your goals. Members of the team may include:
- Nurses or nurse practitioners
- Social workers
- Physical and occupational therapists
- Speech-language pathologists
- Hospice aides
- Music therapists
- Respiratory therapists
As part of the Medicare Hospice Benefit, you will receive all items and services you need for pain relief and symptom management, including:
- Medical, nursing, and social services (intermittent visits and on-call phone support)
- Drugs for pain management, including a pain pump to deliver your medications into your vein or under the skin if oral medications don’t manage your pain
- Durable medical equipment, such as a hospital bed or oxygen
- Aide and homemaker services (intermittent visits)
- Spiritual and grief counseling for you and your family
- Bereavement support for loved ones as needed for up to a year.
Hospice care is intended for terminally ill people (with a life expectancy of six months or less). If you live longer than six months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill.
- You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
- You have the right to change your hospice provider once during each benefit period.
- At the start of the first 90-day benefit period, your hospice doctor and your primary doctor (if you have one) must certify that you’re terminally ill.
What Will Hospice Care Cost With Medicare?
- You pay nothing for hospice care if you receive routine home care, continuous home care, or general inpatient care. If your hospice provider charges you for it, you may pay 5% of the Medicare-Approved Amount for inpatient respite care.
- You may pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. Many hospice agencies don’t charge for your medications as long as they are included in your plan of care. In the rare case the hospice benefit doesn’t cover your drug, your hospice provider should contact your prescription drug plan to see if Part D covers it.
- You must continue to pay your Part B premiums. If you decide to keep your Medicare Advantage Plan, you must pay your plan’s premiums.
What Hospice Care Isn’t Covered By Medicare?
Medicare won’t cover hospice care provided by an agency that isn’t Medicare certified. You must get hospice care from the Medicare-certified provider you choose, and all care must be included in your individualized plan of care and arranged by the hospice team. You can’t get the same type of care from a different hospice unless you change your provider, which you can do once in each benefit period.
Once your hospice benefit starts, Medicare won’t pay for:
- Treatment intended to cure your terminal illness or related conditions.For instance, if you want to pursue chemotherapy for your cancer treatment, hospice under Medicare won’t generally cover it unless it’s considered palliative.
- Prescription drugs to cure your illness (rather than for symptom control or pain relief).
- Room and board. Medicare doesn’t cover room and board if you get routine hospice care in a nursing home or a hospice inpatient facility. If your hospice team determines that you need general inpatient or respite care that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
- Around-the-clock care if you are receiving routine hospice care.
- Care you get in an emergency room or a hospital unless it is arranged by your hospice team or is not related to your terminal illness or related conditions. Medicare doesn’t cover ambulance transport either unless your hospice arranges it. If you are enrolled in hospice and have urgent needs, call your hospice, not 911.
As a hospice patient, you always have the right to stop hospice care at any time. You can continue hospice services later when your condition and plan of care warrant it.
How Do You Start Hospice Care On Medicare?
You may be referred to hospice care by your primary physician, specialist, or someone in your family or community. Whether you are in a facility or living at home, your physician and a hospice physician will need to verify that you qualify for hospice care before an agency can fully admit you for care.
When you agree to hospice care, you’re acknowledging that you choose comfort care instead of curative care. You must sign a statement choosing hospice care instead of other benefits Medicare covers to treat your terminal illness and related conditions.
Most often, your doctor or social services staff at a nursing facility will give you a list of hospices in your area, so you can choose which agency you prefer. You may receive recommendations from others in your community. You can search for and compare Medicare-certified hospice providers in your area here.
If you’re enrolled in a Medicare Advantage Plan and want to start hospice care, ask your plan to help you locate a Medicare-approved hospice provider in your area.
Learn More From Our Sources
- CMS | Fact Sheet: Medicare Advantage Value-Based Insurance Design Hospice Benefit | Last accessed February 2024
- Medicare | Hospice Care | Last accessed February 2024
- Medicare | How Hospice Works | Last accessed February 2024
- Medicare | Search for Hospice Care Near You | Last accessed February 2024
- NHPCO | National Hospice and Palliative Care Organization: History of Hospice Care | Last accessed February 2024
- NHPCO | Hospice Facts and Figures 2021 Edition | Last accessed February 2024