Hospice care has the goal of providing comfort and relief from pain and other symptoms to terminally ill patients during the final days of their life. Hospice may also provide emotional and spiritual care to patients and their families. This type of care is called palliative care.
Hospice can take place in the home or in an inpatient hospice facility, depending on individual circumstances.
Which Part of Medicare Covers Hospice Care?
Medicare Part A, Medicaid and most private insurance plans cover hospice care if you or your loved one meets certain conditions.1 Even if with a Medicare Advantage plan, Medicare Part A will still cover the costs associated with hospice care.
Hospice care can be covered by Medicare if all the below conditions are met for your or your loved one.
1. Your hospice doctor and regular doctor certify you’re terminally ill
2. You accept palliative care (care for comfort only) instead of care to try to cure your illness
3. You sign a statement that shows you choose hospice care over other Medicare-covered benefits for treating your terminal illness and any related conditions.
How Much Does Medicare Pay for Hospice?
If qualified for coverage by meeting the conditions listed above, you pay nothing for hospice care. Medicare Part A will cover all the hospice care costs, unless hospice care is received at home or in a facility like a nursing home. In those two cases, Medicare will not cover room and board.
You or your loved one may have a few costs in general though. There may be a $5 copayment for each prescription drug (or other similar item) for pain relief and symptom control while at home. And, there may also be a charge of 5 percent of the Medicare-approved amount for inpatient respite care.
The hospice benefit under Medicare Part A does not cover curative care. This means the hospice benefit will not pay for any treatment to try and cure the primary or related condition or illness. Keep in mind that a hospice patient can resume curative treatment at any time, but hospice will not pay for it.
If you have Original Medicare (Parts A & B) and need hospice care, Medicare Part A will cover all costs if you meet the eligibility requirements listed above. If you have a Medicare Advantage plan, Medicare Part A still covers the costs associated with hospice care. Contact your plan’s customer service department to speak to a representative if you have questions. Another great resource is the Medicare Hospice Benefits official government booklet from the Centers for Medicare and Medicaid.
1 https://www.medicare.gov/coverage/hospice-care
Medicare Made Clear