Get the Facts About Hospice Care and Medicare

November is National Hospice and Palliative Care Month. Hospice care is compassionate end-of-life care. It includes services intended to provide comfort for terminally ill individuals. Palliative care is specialized medical care, performed to relieve pain and stress, with a focus on the needs of the patient, not on the prognosis.

Medicare provides coverage for hospice care. The National Hospice and Palliative Care Organization (NHPCO) reports that 1.55 million people on Medicare received hospice care in 2018, and 50.7% of people on Medicare who died were enrolled in hospice at the time of death.

How Hospice Works With Medicare

To qualify for hospice care under Medicare, you must have a hospice doctor and your own physician, if you have one, certify that you are terminally ill – your life expectancy is six months or less. When you enroll in hospice, you are agreeing to receive palliative care instead of care to treat the underlying illness. Medicare requires you to sign a statement that you are choosing hospice instead of other Medicare-covered benefits to treat your terminal illness and other related conditions. 

The Medicare-certified hospice care you receive can be delivered in your home or in a facility where you live, such as a nursing home. Medicare does not cover room and board when you receive hospice care in your home or in a facility where you reside. Medicare covers:

• All services and items needed for relief of pain and management of symptoms
• Medical services, nursing services, and social services
• Durable medical equipment needed for pain relief and symptom management
• Pain management drugs
• Aide services
• Homemaker services
• Spiritual and grief counseling for you and your family

Out-of-Pocket Costs With Medicare Coverage for Hospice

You pay nothing for hospice care with Original Medicare. The co-payment is $5 per prescription for outpatient drugs to relieve pain and manage symptoms. If you receive inpatient respite care, you may be required to pay 5% of the amount approved by Medicare. Inpatient respite care is short-term inpatient care provided only when necessary to relieve caregivers who are caring for a patient at home. 

Services Included in Hospice Care

Your hospice team will create a plan based on your terminal illness and any related conditions. The plan may include any or all of these services and items:

• Doctors’ services
• Nursing and medical services
• Physical therapy services
• Speech-language pathology services
• Dietary counseling
• Social services
• Occupational therapy services
• Aide and homemaker services
• Drugs to manage pain
• Durable medical equipment for the management of symptoms and relief of pain
• Grief and spiritual counseling for patient and family
• Short-term inpatient care for the management of pain and symptoms (You must go to a Medicare-approved facility to receive this care)
• Inpatient respite care, delivered at a Medicare-approved facility, for up to five days each visit (Medicare only allows respite care on an occasional basis)
• Any other services covered by Medicare, as recommended by your hospice team, to help manage pain and symptoms related to your terminal illness and other related conditions

If you have questions about hospice Medicare coverage for yourself or a loved one, our agent is happy to help.