The Medicare Hospice Benefit
The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of non-curative medical and support services for their terminal illness. Hospice care also supports the family and loved ones of the patient through a variety of services, enhancing the value of the Medicare Hospice Benefit.
Who is Eligible for Medicare Hospice Benefits?
Hospice care is covered under Medicare Part A (Hospital Insurance). You are eligible for Medicare hospice benefits when you meet all of the following conditions:
- You are eligible for Medicare Part A (Hospital Insurance), and
- Your doctor and the hospice medical director certify that you are terminally ill and you probably have less than six months to live, should the disease run it’s normal course, and
- You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness, and
- You receive care from a Medicare-approved hospice program.
Please note: Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.
What Does Medicare Cover?
Medicare covers these hospice services.
- Physician services
- Nursing care
- Medical equipment (like wheelchairs or walkers) – related to terminal illness
- Medical supplies (like bandages and catheters) – related to terminal illness
- Drugs for pain and symptom management – related to terminal illness
- Short-term care in a hospital, for respite and inpatient for pain and symptom management or Medicare certified Healthcare Facility
- Home health aide and homemaker services
- Physical and occupational therapy and speech therapy – related to terminal illness
- Social work services
- Dietary counseling
- Grief support to help you and your family
Please note: You will only have to pay part of the cost for outpatient drugs.
Respite Care and Medicare?
Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. As a hospice patient, you may have one person who takes care of you every day, like a family member. Sometimes your caregiver needs someone to take care of you for a short time while they do other things that need to be done. During a period of respite care, you will be cared for in a Medicare- approved facility, such as a hospice residential facility, hospital, or nursing home.
The Medicare Hospice Benefit Does Not Cover the Following:
- Treatment intended to cure your terminal illness.
As a hospice patient, you will receive comfort care to help manage symptoms related to your illness. Comfort care includes medications for symptom control and pain relief, physical care, counseling, and other hospice services. Medications not directly related to your hospice diagnosis are not covered under the Medicare Hospice Benefit. Hospice team members will consult with the hospice physician and will inform you and your family which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit. The Hospice uses medications, equipment, and supplies to make you as comfortable and pain- free as possible. Under the hospice benefit, Medicare won’t pay for treatment to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. As a hospice patient, you always have the right to stop receiving hospice services and receive the “traditional” Medicare coverage you had before electing hospice.
- Service from another provider that is the same care that you are getting from your hospice.
All care that you receive for your illness must be given by your hospice team. You may not receive the same type of service from a different provider unless you change your hospice provider.
- Nursing Home Room and Board
Room and board isn’t covered by Medicare. You may receive hospice services wherever you live, even in a nursing home, however, the Medicare Hospice Benefit does not pay for nursing home room and board.
Medicare Hospice Benefits This is a link to a really wonderful booklet published by Medicare about the Medicare Hospice Benefits.