Does Medicare cover Hospice?

If you or a loved one with Medicare benefits requires hospice care, it’s covered by Medicare.

Hospice is care that focuses on providing comfort when a person has stopped receiving treatment for a terminal illness.

If you have Part A of Original Medicare or a Medicare Advantage plan, the hospice care is covered if: ^[i]

• Your Medicare-approved hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of six months or less).
• You accept palliative care (for comfort) instead of care to cure your illness.
• You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness and related conditions.

Medicare pays virtually all costs related to hospice care for a terminal illness. The Medicare hospice benefit pays for everything except:

• You may have to pay a copayment of up to $5 for each prescription drug to manage your pain and symptoms related to your terminal illness.
• If you choose to use the benefit for inpatient respite care to allow a caregiver to rest, you may have to pay 5% of the cost.

While the Medicare hospice benefit pays for everything else related to your terminal illness, it won’t pay for things not directly related to the terminal illness. For example, if you’re in a nursing home, while it will pay for the hospice care itself, it won’t pay for room and board at the nursing home.

The hospice portion of Medicare coverage also won’t directly pay for medical needs beyond the terminal illness, like treating an unrelated disease. Still, Original Medicare or Medicare Advantage will cover you as it did before hospice care for such things.

How long will Medicare pay for hospice care?

Medicare-approved hospice care is for terminal illnesses expected to result in death within six months. As such, hospice care initially provides two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods as needed. ^[i]

At the end of each benefit period, a hospice medical professional must certify that the patient is still considered terminally ill to continue for hospice care.

How much does Medicare pay hospice per day?

There is no minimum or maximum benefit that Medicare will pay within an approved benefit period. With hospice care specifically, there also is no deductible that has to be met and no copayment responsibilities (beyond the charge mentioned above of up to $5 per prescription drug).

The only potential difference between receiving hospice coverage from Medicare at home versus in a facility is that you may have to pay room and board if care is administered in a facility.

Much like a hospice patient at home continuing to pay the mortgage or rent, a hospice patient in a facility may have to pay to stay there. Some areas do have hospice facilities that don’t charge but instead cover room and board costs through fundraising efforts or the like.

Yes, Medicaid covers hospice care like the way Medicare covers it. However, because Medicaid is administered on the state level, each state sets its own rules regarding how long a person with a terminal illness is expected to live before they can begin receiving hospice care. ^[i]