Hospice Coverage and Benefits

To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you’re terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to hospice care, you’re agreeing to comfort care (palliative care) instead of care to cure your illness. You also must sign a statement choosing hospice care instead of other benefits Medicare covers to treat your terminal illness and related conditions. Coverage includes:

  • All items and services needed for pain relief and symptom management
  • Medical, nursing, and social services
  • Drugs for pain management
  • Durable medical equipment for pain relief and symptom management
  • Aide and homemaker services
  • Other covered services you need to manage your pain and other symptoms, as well as spiritual and grief counseling for you and your family.
  • Medicare-certified hospice care is usually given in your home or other facility where you live, like a nursing home.

Your costs in Original Medicare

  • You pay nothing for hospice care.
  • You pay nothing for each prescription for outpatient drugs for pain and symptom management related to primary diagnosis. All other medications will continue to be paid for as usual through your Part D medication coverage.

What it is

Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services:

  • Doctors' services
  • Nursing and medical services
  • Durable medical equipment for pain relief and symptom management
  • Medical supplies, like bandages or catheters
  • Drugs for pain management
  • Aide and homemaker services
  • Physical therapy services
  • Occupational therapy services
  • Speech-language pathology services
  • Social services
  • Dietary counseling
  • Spiritual and grief counseling for you and your family
  • Short-term inpatient care for pain and symptom management. This care must be in a Medicare approved facility, like a hospice facility, hospital, or skilled nursing facility that contracts with the hospice.
  • Inpatient respite care , which is care you get in a Medicare-approved facility (like an inpatient facility, hospital, or nursing home), so that your usual caregiver (like a family member or friend) can rest. Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but only on an occasional basis.
  • Any other services Medicare covers to manage your pain and other symptoms related to your terminal illness and related conditions, as your hospice team recommends.

Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).

Things to know

Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (at a face-to-face meeting) that you’re still terminally ill. Hospice care is usually given in your home but may also be covered in a hospice inpatient facility. Original Medicare will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions. When you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren't working. Once you choose hospice care, your hospice benefit will usually cover everything you need.

Medicare won't cover any of these once your hospice benefit starts:

  • Treatment intended to cure your terminal illness and/or related conditions - Talk with your doctor if you're thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
  • Prescription drugs to cure your illness - Rather than for symptom control or pain relief).
  • Care from any hospice provider that wasn't set up by the hospice medical team - You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you've chosen him or her to be the attending medical professional who helps supervise your hospice care.
  • Room and board - Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
  • Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation - Unless transportation is either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

Contact your hospice team before you get any of these services or you might have to pay the entire cost.

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