Dear Marci,
My mother has several serious health complications, and her condition has deteriorated in the past few weeks. Her doctor has diagnosed her as terminally ill and recommended that we consider transitioning her to hospice care, but I am concerned about the costs and coverage. How does Medicare cover hospice care and what are the costs?
– William (Trenton, NJ)
Dear William,
Medicare covers hospice care if you meet certain criteria. Hospice care is comprehensive care for people who are terminally ill that includes pain management, counseling, respite care, prescription drugs, inpatient and outpatient care, and services for the terminally ill person’s family.
In order to qualify for the hospice benefit, you must meet the following criteria:
- Have Medicare Part A;
- The hospice medical director (and your doctor, if you have one) must certify that you have a terminal illness, meaning that your life expectancy is six months or less;
- You sign a statement electing to have Medicare pay for palliative care, such as pain management, rather than care to try to cure your condition;
- Your terminal condition is documented in your medical record; and
- You receive care from a Medicare-certified hospice agency.
If you are considering hospice care, speak with your doctor about finding a Medicare-certified hospice agency. The hospice medical director and your doctor will certify your eligibility. You must sign a statement electing hospice care and waiving curative treatments for your terminal illness. The hospice team of providers must consult with you to develop a plan of care. The team includes a hospice doctor, a registered nurse, a social worker and a counselor.
Hospice can be provided in the home or in an inpatient facility; you do not have to be homebound to qualify for the hospice benefit. The hospice benefit covers the following services related to your terminal condition:
- Nursing services
- Skilled therapy services
- Home health aide services
- Durable medical equipment and medical supplies
- Short-term inpatient care to give relief to your caregivers
- Short term inpatient care to manage symptoms and control pain
- Medical social services
- Some prescription drugs
- Spiritual or religious counseling care
- Nutrition and dietary counseling
The hospice benefit is always covered under Original Medicare. Even if you have a Medicare Advantage plan, Original Medicare Part A will cover your hospice care. Your Medicare Advantage plan will continue to pay for your care that is unrelated to your terminal condition.
Original Medicare covers most costs associated with hospice care. You will be responsible for paying up to $5 for outpatient prescription drugs covered through the hospice benefit (prescription drugs related to pain relief and symptom control). You also will pay a copay of no more than 5 percent of the Medicare approved amount for each day of inpatient respite care.
While you have hospice, you can still get Medicare coverage for treatment of all illnesses and injuries unrelated to your terminal condition. However, the costs you usually pay for services will apply.
Medicare will cover the hospice benefit as long as you continue to qualify for hospice care. If you receive 180 days of hospice care, you must have a face-to-face meeting with a hospice doctor or nurse practitioner to confirm that you still qualify for hospice care. You also can end hospice care at any time and elect to receive curative treatments for an illness.
-Marci