Does Medicare pay for Hospice? Everything you need to know

Medicare is a vital resource for approximately 20% of the U.S. population, providing crucial health benefits to those who qualify and one of the services covered by Medicare is hospice care, so how does it work? Will Medicare pay for it?

Hospice care is care offering comfort and palliative care to terminally ill individuals as they enter the final phase of their lives. However, it's important to understand the specific criteria and coverage details for this service.

To qualify for Medicare-covered hospice care, you must meet certain conditions under Medicare Part A (Hospital Insurance).

Firstly, both your hospice doctor and your primary physician need to confirm that you have a terminal illness, with a life expectancy of six months or less. You must also agree to receive comfort care, based on managing symptoms and enhancing quality of life, rather than cures.

Furthermore, you will need to sign a statement indicating your choice of hospice care over other Medicare-covered treatments.

What Does Medicare Cover in Hospice Care?

Once enrolled in hospice care, Medicare covers a comprehensive range of services. These include pain management, nursing care, and medical supplies, along with counseling and bereavement for families.

Medicare typically provides hospice care at home, a nursing home, or an inpatient hospice facility. In cases where inpatient care is required at a hospital, the hospice team will coordinate the arrangements, but beware that if they don't, you may be liable for the entire cost.

You won't pay out-of-pocket for most hospice care services if they are provided by a Medicare-approved hospice provider. However, there are some exceptions. For example, you may need to pay a copayment of up to $5 for each prescription for outpatient medications for symptom management.

If your hospice provider doesn't cover a drug, they will check if Medicare Part D will pay for it.In addition, you may have a 5% copayment for inpatient respite care, but it won't exceed the annual inpatient hospital deductible.

Medicare hospice coverage: What isn't included?

While Medicare covers a significant portion of hospice care, there are certain limitations. For instance, it does not cover treatments intended to cure your terminal illness or drugs prescribed for curative purposes.

Also, Medicare only covers services provided by the hospice care team, and you cannot receive hospice services from a different provider unless you switch your hospice provider. Additionally, room and board are not covered in certain settings, such as at home or in a nursing home.

By understanding the details of Medicare's hospice care benefits, you can make informed decisions for you or your loved ones when facing terminal illness.