Does Medicare Pay for Hospice Care?
Key takeaways:
Hospice care describes end-of-life services that bring comfort to someone who is terminally ill. The care is designed to improve quality of life and not to provide medical treatment for an illness.
Original Medicare will pay for all costs related to your hospice care.
If you are enrolled in another Medicare plan, your hospice care will be covered by original Medicare. If you have a Medicare Advantage, you can remain in your plan as long as you continue to pay the premiums.
Hospice care is a comprehensive support program provided to someone who has a terminal illness and chooses to forgo treatments to prolong life. This person is usually expected to live for less than 6 months. A hospice team of professionals and caregivers focuses on care, comfort, and quality of life. Most often, services are provided in your home. Hospice care is covered under Medicare Part A.
Who is eligible for Medicare coverage of hospice care?
To be eligible for hospice under Medicare, your hospice doctor or your physician must certify that you are terminally ill. Terminally ill means that you are expected to live 6 months or less. You must sign a document that says you are choosing hospice care instead of having Medicare pay for treatment of your terminal illness and related conditions.
How much does Medicare pay for hospice per day?
Hospice care will usually cover most of your healthcare needs. The 2022 hospice payment rates for hospices that submit quality data to the Centers for Medicare & Medicaid Services are:
Routine home care per day (days 1-60): $203.40
Routine home care per day (days 61+): $160.74
Continuous home care (24 hours of care): $1,462.52
Inpatient respite care per day: $473.75
General inpatient care per day: $1,068.28
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What hospice costs are covered under Medicare?
Hospice care under Medicare covers:
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 also will pay for other covered benefits for any health issues that are not part of your terminal illness and related conditions.
How long will Medicare pay for hospice care?
Hospice care is for people with a life expectancy of 6 months or less. If you live for longer than 6 months, Medicare will continue to cover hospice care as long as the hospice medical director or other hospice doctor recertifies that you are terminally ill.
You can receive hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods.
Do original Medicare and Medicare Advantage plans offer different coverage amounts for hospice?
If you choose hospice care, original Medicare will cover everything related to your terminal illness. These services will be covered whether you decide to stay in a Medicare Advantage plan or any other Medicare plan.
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If you were originally in a Medicare Advantage plan, you can keep that plan for services unrelated to your terminal illness as long as you continue to pay the plan premiums.
How much does hospice care cost me out of pocket?
There is no cost for hospice care provided to you, family members, or caregivers. There’s also no deductible. You will have out-of-pocket costs for items and services related to hospice care, though, including:
Your monthly Medicare Part A and Medicare Part B premiums.
A $5 copayment for each outpatient prescription drug you need for pain and symptom management.
You also may pay 5% of the Medicare-approved amount if you need inpatient respite care. Respite care provides substitute caregiving for you in a facility such a hospital or nursing home to give your usual caregiver a break. You can stay up to 5 days for each respite period. Respite care can only be provided on an “occasional” basis.
If you have Medigap, that supplemental insurance will cover out-of-pocket costs for prescription drugs and respite care.
Are you allowed to stop and resume hospice and still retain Medicare coverage?
You have the right to stop hospice care at any time. If your condition improves or your illness goes into remission, you can end hospice services. You should not sign or date any forms until the actual day you want to stop hospice care. Once you stop hospice care, you can go back to your Medicare Advantage if you have been paying the premium. Original Medicare enrollees can continue coverage with original Medicare.
Does Medicare cover respite care or grief counseling?
Medicare hospice benefits include respite care and grief counseling. Respite care provides substitute caregiving for you in a Medicare-approved facility to give your caregiver a break. Hospice care also provides grief and loss counseling for you and your family.
The bottom line
You may one day choose hospice care instead of treatment for a serious illness that cannot be cured. Hospice services bring you and your family holistic comfort and support. Medicare provides hospice care at no charge and without you meeting a deductible. Medicare will cover hospice care for original Medicare enrollees and those covered by a Medicare Advantage plan. There are small out-of-pocket costs for pain and symptom management medications as well as respite care.
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References
Centers for Medicare & Medicaid Services. (2021). Hospice.
Centers for Medicare & Medicaid Services. (2021). Medicare program; FY 2022 hospice wage index and payment rate update, hospice conditions of participation updates, hospice and home health quality reporting program requirements. Federal Register.
Centers for Medicare & Medicaid Services. (2022). Medicare hospice benefits.
Medicare.gov. (n.d.). Hospice care.
Medicare.gov. (n.d.). How hospice works.
National Institute on Aging. (2021). What are palliative care and hospice care?
